Statins Bring Many People With Obesity Level With Healthy-Weight Peers on Cholesterol and Blood Pressure, Study Finds

Key Takeaways:

• Among adults over 40 in high-income countries, gaps in cholesterol and blood pressure between people with obesity and those of a healthy weight have narrowed or vanished.
  
• The convergence is driven largely by wider use of statins and blood-pressure medications among people living with obesity.
  
• In adults under 40, people with obesity still show higher cholesterol and blood pressure, and obesity continues to raise the risk of other conditions.
  
  
  

A narrowing gap in cardiovascular risk 

Many adults living with obesity now have cholesterol and blood pressure readings that are “indistinguishable” from those of people at a healthy weight, largely because of the use of statins, a major new study has found. In some cases, researchers reported, people with obesity were “better off” than their healthy-weight counterparts.

Historically, adults with obesity were more likely to have raised blood pressure and higher levels of unhealthy cholesterol. The study found, however, that differences in unhealthy cholesterol and blood pressure have “narrowed or disappeared” among people aged 40 and over.

Experts attribute the shift chiefly to the greater use of cholesterol-lowering medications, such as statins, and blood-pressure treatments – both of which are more commonly prescribed to people living with obesity. They said the findings were important to “give a picture of the cardiovascular health” of the population most likely to be offered weight-loss medications, whose popularity has risen rapidly, and warned that it was important not to “lose sight” of these results as more people take such drugs.

What the researchers examined

The study, published in the Lancet, drew on data from almost 1 million adults aged 20 to 79 across England, Japan, South Korea, Taiwan, Thailand, Finland and the United States. Researchers analysed blood pressure, cholesterol levels and body mass index (BMI) scores recorded in 110 health surveys carried out between 1990 and 2024. They also reviewed the use of cholesterol-lowering drugs and blood-pressure treatments, known as antihypertensives.

The team found that unhealthy cholesterol levels and blood pressure “declined over time”, particularly among people aged 40 and over. Those declines were larger among people with obesity, “leading to a convergence of these risk factors between obesity and normal BMI in people older than 40 years”.

The researchers wrote: “As a result of these trends, in England, the US, Thailand, South Korea, and Japan, older people with obesity often became indistinguishable from, or better off than, those with normal BMI in terms of non-HDL cholesterol and SBP (systolic blood pressure).”

They added: “We found that differences in non-HDL cholesterol and SBP between those with obesity and those with a normal BMI narrowed or disappeared, especially in older adults, in some cases making those with and without obesity indistinguishable in terms of these cardiometabolic traits.”

Why the gap has closed

Prof Majid Ezzati, from the School of Public Health at Imperial College London, said: “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 [body mass index].

“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.”

Younger adults remain at higher risk

The convergence was not seen across all age groups. In adults under 40, people with obesity still had higher levels of unhealthy cholesterol and higher blood pressure than their healthy-weight peers.

One of the research team, Prof Edward Gregg from Imperial College London, stressed that “it doesn’t mean that obesity does not still increase your risk of other outcomes”.

Another of the authors, Yse d’Ailhaud de Brisis, also from Imperial College London, said: “While good news for older adults with obesity, our results suggest that cardiovascular health risks remain higher for adults under 40 than for their counterparts with a normal BMI.

“Early lifestyle interventions, screening and, when appropriate, medication in this younger group should be considered to prevent long-term cardiovascular complications linked to obesity.”

A public health success, with caveats

Commenting on the study, Prof Bryan Williams, the chief scientific and medical officer at the British Heart Foundation, said: “This study highlights a powerful public health success story – it shows just how effective modern treatments for blood pressure and cholesterol have become, with many people over 40 with obesity now reaching levels similar to those with a healthy weight.

“But 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.”