Study finds heart health is improving in obese adults, experts urge caution

A UK-based study has investigated differences in blood pressure, cholesterol, and consumption of antihypertensive and lipid-lowering medicines in obese and normal-weight participants to determine the role body mass index (BMI) plays in these metabolic health conditions. However, independent experts and study authors point out that the study cannot rule out other contributing factors, such as diet and lifestyle. 

The study used data from over a million people from national population databases between 1990 and 2024, using data from seven countries: South Korea, Japan, Thailand, Taiwan, England, Finland, and the US.

The researchers found that obese or overweight adults aged 40 and above, especially those aged between 60 and 79, had more sharply declining systolic blood pressure and non-HDL cholesterol levels compared to the same age group in the normal weight range.

In some countries, older obese people had similar to, or sometimes better, systolic blood pressure and cholesterol levels than people with normal BMIs.

However, people aged below 40 had a significant metabolic gap between those who were overweight or obese, compared to those having a BMI in the normal weight range. This means that the younger obese population in the study had higher blood pressure and cholesterol levels compared to the normal weight population.

The study authors say that the findings imply that taking medication to lower blood pressure and cholesterol has helped middle-aged and older adults in high-income countries to lower their cardiovascular risk to levels that are similar to those of people with normal BMI.

Furthermore, the American College of Cardiology and American Heart Association recently told Nutrition Insight about its updated dyslipidemia management guidelines, focusing on lifestyle interventions and earlier detection. They highlighted the importance of following healthy diets, such as the Mediterranean, DASH, and vegetarian diets, as first-line treatment for high LDL cholesterol.

“At a time when 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,” says study author Majid Ezzati, professor at the School of Public Health at Imperial College London, UK.

However, independent experts commenting on the study caution against interpreting its results this straightforwardly. They stress that blood pressure and cholesterol treatments are part of the obesity problem, but far from the solution.

Experts stress that blood pressure and cholesterol treatments are part of the obesity problem, but far from the solution.Cautioning of results

Dr. Marie Spreckley, research program manager and researcher, Prevention of Diabetes and Related Metabolic Disorders in High Risk Groups, University of Cambridge, UK, is one of the independent experts commenting on the study, published in The Lancet.

“This is a large, high-quality observational study that combines data from 110 nationally representative surveys, including almost one million adults across seven industrialized countries over more than three decades,” she says.

“Its major strengths include its scale, the use of objectively measured BMI, blood pressure, and cholesterol, nationally representative populations, and a consistent analytical approach to examining long-term trends.”

However, she stresses that, as with any observational study, the findings cannot establish cause and effect. She notes that the authors appropriately acknowledge that changes over time in factors such as diet, smoking, physical activity, preventive care, and evolving clinical guidelines may also have contributed to the observed trends.

She adds that the analysis was limited to seven industrialized countries, with important differences observed between countries, so the findings should not be assumed to apply universally.

“Importantly, these findings should not be interpreted as showing that obesity has become benign. The study examined cardiovascular risk factors rather than cardiovascular events or mortality, so it cannot determine whether improvements in blood pressure and non-HDL cholesterol translate into proportional reductions in cardiovascular events or mortality,” she stresses.

“The persistence of lower HDL cholesterol among people with obesity also highlights that improvements in some cardiometabolic risk factors do not equate to complete normalization of metabolic health.”

The study highlights the increasing role of weight loss, cholesterol, and blood pressure medications throughout the last three decades for obese people.Role of pharma

The study highlights the increasing role of weight loss, cholesterol, and blood pressure medications throughout the last three decades for obese people.

The researchers observed a difference between countries, with England and the US having 70–72% of obese or overweight men taking cholesterol-lowering medications, in comparison to 40–48% with a normal BMI. This may have impacted the results and reduced cardiovascular disease risk.

“That is a significant public health success story, and one we should not lose sight of as new weight-loss medications enter the picture,” comments study co-author Lakshya Jain, researcher at the School of Public Health at Imperial College London. 

GLP-1 medications are increasing in popularity and are also known for lowering cholesterol and blood pressure, and some are recognized by the US FDA to reduce the risk of cardiovascular disease.

However, with GLP-1 weight loss medications on the rise, there follows an increased need for following nutritional guidelines, especially when discontinuing the medication to avoid regaining weight.

Naveed Sattar, professor of Cardiometabolic Medicine/Honorary Consultant at the University of Glasgow, UK, comments that controlling cholesterol and blood pressure, while essential, is no longer enough.

“A strategy focused solely on managing downstream risk factors may help people live longer, but it can also mean more individuals living longer with obesity and subsequently developing more chronic conditions,” he stresses.

“We can no longer afford to view obesity management as optional. Effective prevention and treatment of obesity must sit alongside optimal cardiovascular risk management if we are to meaningfully reduce the growing burden of chronic disease and so increase disability-free life years.” 

He concludes that cholesterol and blood pressure treatments are important parts of the solution, “but they are now far from the whole solution.”