A major international study published in The Lancet has revealed that the traditional gap in cardiovascular risk factors between obese and normal-weight older adults has effectively disappeared, thanks to widespread use of cholesterol-lowering statins and blood pressure medications like ramipril. Researchers analyzed nearly one million adults aged 20 to 79 across seven countries and found that among those over 40, obese individuals now have non-HDL cholesterol and systolic blood pressure levels comparable to—or even better than—their normal-weight peers.
Key Findings from the Global Analysis
The study examined data from 110 health surveys conducted between 1990 and 2024 in England, Japan, South Korea, Taiwan, Thailand, Finland, and the USA. The team focused on trends in body mass index (BMI), blood pressure, and cholesterol levels, alongside usage of antihypertensives and lipid-lowering drugs. In all high-income countries studied, the historical disadvantage in cardiovascular risk for obese adults over 40 had narrowed or vanished. In some cases, such as in England, the USA, Thailand, South Korea, and Japan, older adults with obesity were actually better off than those with a normal BMI in terms of non-HDL cholesterol and systolic blood pressure.
Why the Convergence Occurred
Professor Majid Ezzati from Imperial College London explained: “Our study suggests that, in high-income countries, taking medication to lower blood pressure and cholesterol has helped middle-age and older adults lower their cardiovascular risk to levels that are similar to people with normal BMI.” The researchers attribute the convergence primarily to the widespread prescription and adherence to statins and antihypertensives among obese individuals, who are more likely to be prescribed these medications. Co-author Lakshya Jain noted: “This latest analysis suggests that the observed convergence… is largely due to statins and other widely accessible medications to reduce cardiovascular risk. That is a significant public health success story.”
Implications for Weight-Loss Drug Era
The findings come at a time when weight-loss medications such as Ozempic and Wegovy are rapidly gaining popularity. Professor Ezzati emphasized: “At a time that weight-loss medications are becoming more widely used, our results give a picture of the cardiovascular health of people likely to be prescribed them, which allows the healthcare system to understand how blood pressure and cholesterol treatments benefit the population alongside weight-loss medications.” The study serves as a benchmark for understanding baseline cardiovascular health in candidates for these new drugs.
Younger Adults Still at Risk
The picture was different for adults under 40. In this younger group, obese individuals still had significantly higher bad cholesterol and blood pressure compared to their normal-weight counterparts. Author Yse d’Ailhaud de Brisis warned: “While good news for older adults with obesity, our results suggest that cardiovascular health risks remain higher for adults under 40… Early lifestyle interventions, screening and, when appropriate, medication in this younger group should be considered to prevent long-term cardiovascular complications linked to obesity.”
Expert Caution on Broader Obesity Risks
Despite the positive trends, experts urged caution against complacency. Professor Edward Gregg from Imperial College stressed that “it doesn’t mean that obesity does not still increase your risk of other outcomes.” Professor Bryan Williams, chief scientific and medical officer at the British Heart Foundation, added: “We must not lose sight of the bigger picture. These medications are needed because of the adverse effects of obesity on cardiovascular disease risk. Moreover, obesity still affects the body in many other ways and increases the risk of other health problems, including diabetes, kidney disease and some cancers.” He concluded: “Preventing and reducing obesity would result in a range of health benefits, in many cases without the need for these additional medicines.”
