Obesity Medication Significantly Reduces Risk of Infections and Serious Cardiovascular Events
Key Takeaways:
- Tirzepatide cut the combined risk of heart attack, stroke and death by around a third compared with sitagliptin over one year.
- Hospital admissions for infection fell by 36 per cent, and infection-related deaths by 60 per cent.
- Real-world insurance data offers evidence on GLP-1 medications that clinical trials have not yet produced.
A large real-world comparison of two diabetes medicines
People living with type 2 diabetes and obesity may gain substantially more than improved blood glucose control from treatment with tirzepatide. New research indicates that the medication, marketed as Mounjaro, is associated with roughly a one-third reduction in the risk of heart attack and a similar reduction in hospital admissions for infection, when compared with a conventional diabetes medication.
The findings come from researchers at the Technical University of Munich (TUM) and Harvard Medical School, who used health insurance data to examine how the drug performs outside the tightly controlled conditions of a clinical trial. Their study has been published in The BMJ.
What the researchers did
The team analysed a large dataset drawn from United States health insurance providers, comparing outcomes among people treated with tirzepatide against those treated with sitagliptin. Sitagliptin was chosen deliberately: it is a diabetes medication regarded as neutral with respect to cardiovascular outcomes, which makes it a useful yardstick for isolating any additional benefit attributable to tirzepatide.
That design matters. Rather than measuring tirzepatide against a placebo, the researchers set it against an established, widely used treatment that people with type 2 diabetes might realistically be prescribed instead – a comparison closer to the decisions clinicians and patients actually face.
Cardiovascular events reduced by around a third
The results pointed to clear advantages for the GLP-1 medication, a class that has drawn considerable public attention in recent years for its effects on weight.
After one year, 4.4 per cent of people treated with the comparator drug had experienced a heart attack or a stroke, or had died. Among those treated with tirzepatide, the figure was 2.9 per cent. The gap corresponds to a relative risk reduction of approximately one third.
Expressed in absolute terms, the difference of roughly 1.5 percentage points over a single year is meaningful in a population already carrying elevated cardiovascular risk from both type 2 diabetes and obesity.
Fewer hospital admissions for infection
The second set of findings was less anticipated. Significantly fewer people treated with tirzepatide were admitted to hospital with infections, with the associated risk reduced by 36 per cent. The risk of dying from an infection was reduced by as much as 60 per cent.
“The data on infections surprised us because the findings were so striking,” says Dr. Nils Krüger, first author of the study and a resident physician in the Department of Cardiovascular Diseases at TUM University Hospital. “Previous studies have suggested that people treated with GLP-1 agonists are less likely to be hospitalized for infections and less likely to die from them.”
In other words, the direction of the signal was not new – but its size was.
Why obesity may affect the immune response
According to Dr Krüger, the reasons behind the association are not yet fully understood. One plausible explanation lies in the relationship between excess adiposity and chronic inflammation.
“There is evidence that obesity promotes inflammatory processes in the body, which may in turn impair immune function. The exact mechanisms and whether this apparent benefit would also occur without weight loss now need to be investigated.”
That final point is the crux of the open question. If the protective effect is driven principally by weight loss, it would be expected to accompany any effective weight management intervention. If it persists independently of weight change, it would suggest something about the medication’s action on inflammatory or immune pathways that has yet to be characterised. Distinguishing between those possibilities will require dedicated research.
Building healthcare professionals’ understanding of how medications in this class work – and how to interpret emerging evidence about their wider effects – is the focus of professional training such as the College of Contemporary Health’s GLP-1RAs in Focus, a CPD-accredited online short course.
How routine clinical data complements traditional trials
In Dr Krüger’s view, studies that draw on routine clinical data to compare the effects of medications are an important complement to conventional clinical trials. This is particularly true for GLP-1 agonists such as tirzepatide and semaglutide, sold as Mounjaro, Wegovy and Ozempic.
Because these medications have been on the market for a relatively short time, only a small number of large-scale studies have examined the full range of effects associated with the class. Medical societies and regulatory authorities need more research of this kind to underpin their recommendations.
There is also a practical problem that database research helps to solve. “Clinical trials are increasingly comparing active ingredients with one another,” says Dr Krüger. Regulatory authorities, however, often also require comparisons against the established standard of care rather than against another modern drug – a requirement that raises an ethical difficulty if it means assigning trial participants to older treatment while withholding a therapy that may benefit them.
“Database studies that are benchmarked against the results of traditional clinical trials can fill this gap without actually withholding potentially beneficial therapies such as GLP-1 agonists from study participants,” he says.
What this means for clinical decision-making
By enabling a direct comparison with standard diabetes treatment, Dr Krüger hopes the study will provide an additional tool to support decision-making by patients and their physicians.
For healthcare professionals supporting people who live with both type 2 diabetes and obesity, the practical implication is that the conversation about tirzepatide may extend well beyond glycaemic control and weight. Cardiovascular protection and, potentially, resilience to serious infection now form part of the evidence that can be weighed when treatment options are discussed.
As with all analyses of routinely collected data, the findings describe an association rather than establishing cause and effect, and the mechanisms behind the infection results remain to be confirmed. What the study adds is real-world evidence at a scale, and against a comparator, that trials have not yet delivered.
CCH insight
It seems that every week we learn of a new benefit attributable to GLP-1 based medications – this time a significant reduction in infections in patients taking tirzepatide. In view of the links between central adiposity and vitamin D deficiency, and the fact that vitamin D plays an important role immunity, it would be interesting to know if these results might be linked to improved vitamin D status as a result of abdominal fat loss.
Findings like these show how quickly the evidence base around GLP-1 medications is expanding, and how much rests on the professionals discussing these treatments understanding both how they work and how to appraise new data with confidence. CCH’s GLP-1RAs in Focus – Why Drugs Like Ozempic Work CPD short course (2 CPD hours, fully online, CPD-accredited) gives healthcare professionals, whether or not they prescribe, a clear grounding in the science behind medications such as tirzepatide, where they fit in treatment pathways, and how to weigh emerging evidence critically.
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One Avocado a Day May Lower a Hidden Heart Disease Risk in Adults Living With Obesity
Key Takeaways:
- Adults living with obesity who ate one avocado a day for six months showed a fall of 49 nanomoles per litre in LDL particle concentration – equivalent to roughly a 4% reduction in heart disease risk.
- LDL particle number is a risk factor distinct from LDL cholesterol itself, and it tends to be higher in people with abdominal obesity, meaning two people with identical cholesterol readings can carry very different levels of risk.
- The benefit appeared consistently across sex, race, ethnicity, age and body mass index, suggesting that a single, sustainable dietary addition can shift a meaningful cardiometabolic marker without any wider change to diet or activity.
A single dietary change, made in the real world
Adding one avocado to the daily diet may reduce heart disease risk in adults living with obesity, according to research led by the Penn State Department of Nutritional Sciences and published in the Journal of Clinical Lipidology.
The team found that regular avocado consumption was associated with a lower concentration of low-density lipoprotein (LDL) particles – the protein particles that transport cholesterol around the body – in the blood. That reduction corresponded to an approximate 4% decrease in heart disease risk.
What distinguishes the finding is its modesty. Rather than testing a wholesale dietary overhaul, the researchers examined what happens when people make one addition and otherwise carry on as normal.
“If people want to improve the quality of their diet, making one small change might be a more feasible strategy than attempting to change their entire diet,” said Janhavi Damani, postdoctoral scholar at Penn State and first author of the study. “For people with obesity, including avocados in their daily diet might be a good starting place.”
Why particle number matters, not just cholesterol
LDL particles represent a risk factor for heart disease that is separate from LDL cholesterol – the so-called “bad cholesterol” that is itself a significant contributor to risk. The risk posed by LDL particles is typically higher in people with abdominal obesity, the researchers noted.
The distinction rests on a point of basic physiology that standard lipid panels do not capture. LDL cholesterol cannot travel through the body unaided; it must be carried by a protein particle. When a greater number of protein particles are involved in transporting the same quantity of cholesterol, heart disease risk rises – even though the measured cholesterol figure is unchanged.
Damani illustrated the point directly.
“Imagine two people with the same high levels of LDL cholesterol,” Damani said. “Person A carries their cholesterol in fewer, larger LDL particles, and Person B carries their cholesterol in more, smaller LDL particles. Person B’s heart disease risk would be higher because their overall particle count is higher even though a test of their LDL cholesterol would look identical.”
How smaller particles do more damage
Those smaller particles penetrate artery walls more easily and contribute to the accumulation known as plaque, Damani explained.
Plaque raises heart disease risk through two mechanisms working together. It narrows the space available for blood to pass through a vessel, and it reduces the vessel’s flexibility. The consequence becomes clearest under load: when a person’s heart is working hardest – through exertion, heat, stress or any other cause – their blood pressure rises more sharply than it otherwise would, because the vessel can no longer expand to accommodate the increased demand. That failure to compensate can be enough to trigger a cardiac event such as a heart attack.
This mechanistic detail matters clinically, because it explains why particle count can carry prognostic weight even when a patient’s cholesterol result looks reassuring. Practitioners working in weight management and cardiometabolic care increasingly need to interpret markers of this kind alongside anthropometric measures, and this is territory that CCH’s CPD short course provision in obesity care covers in some depth.
Inside the Habitual Diet and Avocado Trial
For this analysis, the researchers drew on data originally collected from 786 participants in the Habitual Diet and Avocado Trial, a six-month study of adults aged 25 years and older.
Eligibility was defined by waist circumference. Men qualified if their waist circumference exceeded 102 centimetres (40 inches); women qualified if theirs exceeded 89 centimetres (35 inches).
Participants were divided into two groups. Half were instructed to maintain their usual diet and activity levels. The other half were provided with one avocado to consume each day and were also instructed to maintain their usual diet and activity levels. No other dietary guidance or restriction was applied.
The original Habitual Diet and Avocado Trial had already established that adding avocado to the diets of people living with obesity did not alter weight or waist circumference, but could reduce levels of LDL cholesterol.
What the blood samples showed
In the current study, the researchers compared blood samples collected at the start and at the end of the six-month period.
Across the study, LDL particle levels in the avocado-per-day group fell by 49 nanomoles per litre. That change corresponded to an approximate 4% reduction in heart disease risk, according to the researchers.
The team was careful to set this figure in proportion.
“Four percent is a modest reduction compared with the 14% to 29% lower heart disease risk associated with improving the overall diet,” Damani said. “However, it is a step in the right direction.”
A consistent effect across the study population
One of the more notable findings concerned who benefited. Regardless of participants’ sex, race, ethnicity, age or body mass index, they were equally likely to experience improvements in LDL particle levels.
The researchers took this to indicate that anyone living with obesity could benefit from avocado consumption. They added a clear caveat, however: people should speak to a registered dietitian nutritionist or their physician for personalised, expert guidance on improving their diets.
From controlled conditions to unpredictable lives
The study’s most significant contribution may lie less in the size of the effect than in the setting in which it was demonstrated.
“Penn State researchers demonstrated several years ago that avocado consumption could reduce LDL cholesterol and levels of LDL particles,” said Kristina Petersen, associate professor of nutritional sciences and senior author of this study. “But in that study, the researchers controlled participants’ entire diets throughout the experiment. This study demonstrated benefits in the real world, where people’s diets are much less predictable. In the course of people’s normal lives, avocado consumption still contributes to a healthier diet.”
That shift – from a tightly controlled feeding study to free-living participants managing their own meals – is what makes the result relevant to everyday practice. A 4% reduction achieved under laboratory conditions tells clinicians relatively little about what patients will actually sustain. A comparable reduction achieved by people eating as they normally do, with one addition, is a different kind of evidence.
What this means for practice
For healthcare professionals supporting people living with obesity, the findings reinforce a familiar principle with fresh quantitative backing: incremental, achievable changes can move clinically meaningful markers. They also underline the value of looking beyond standard lipid measurements when assessing cardiovascular risk in patients with abdominal obesity, where LDL particle number may reveal risk that a conventional cholesterol result conceals.
None of this positions a single food as a substitute for comprehensive care. The researchers’ own framing is deliberately measured – a step in the right direction, not a solution. But in a field where adherence often determines outcomes more than the theoretical strength of an intervention, feasibility is itself a clinical variable worth taking seriously.
CCH insight
It is always re-assuring to hear about studies which show clear benefits of foods we associate with good health, so this is great news for people who eat avocados regularly and a nice reminder for others to maybe eat them more often. However, high cholesterol and other risk factors for cardiometabolic diseases are most common in populations of high deprivation, who are unable to buy avocados regularly due partly to access but mainly due to cost.
This study’s practical value lies in feasibility – one addition, sustained over six months, moving a real marker of cardiovascular risk. Translating that kind of evidence into advice patients will actually follow is the core skill of nutritional care in obesity management. CCH’s Nutrition & Weight Management Essentials (6 hours, fully online, CPD-accredited) gives healthcare professionals a solid grounding in fundamental nutrition concepts, the factors driving weight gain, and evidence-based approaches to both weight loss and long-term maintenance, with real-life case studies throughout.
Explore Nutrition & Weight Management Essentials →
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Beyond the Scales: Why Physical Activity Remains Central to Obesity Care
Key Takeaways:
- Exercise earns its place in obesity care through benefits the scales never show – lower blood pressure, better insulin sensitivity and improved fitness – so it remains worthwhile even when weight changes little.
- On its own, activity shifts the scales only modestly, but paired with diet, obesity medications or surgery it protects lean muscle, drives fat loss and makes the results last.
- Tools such as the 5A consultation model, wearables and app-based coaching can lift adherence, though their value depends on access, accuracy and how well they fit each person’s life.
How much weight someone loses has long been the headline measure of whether obesity treatment is working. A new scientific statement from the American Heart Association, published in Circulation, makes the case that this measure misses much of what physical activity actually does. Movement, the statement argues, reshapes cardiovascular and metabolic health in ways that a set of weighing scales will never register.
What activity does that the scales cannot capture
Obesity sits at the centre of cardiovascular risk because of the company it keeps: raised blood pressure, disordered blood fats and insulin resistance. With roughly 42% of adults in the United States affected, the stakes are considerable, and treatment has traditionally pursued two linked aims, shedding weight and lowering heart disease risk.
Physical activity contributes to both, but the more interesting finding is how much it achieves on its own terms. Regular exercise lowers blood pressure, sharpens the body’s response to insulin and nudges cholesterol and other lipids in a healthier direction, and it does so whether or not the number on the scales falls. Aerobic and resistance training each deliver. As a rough rule, doing more tends to help weight-related outcomes most, while working harder pays off most for cardiorespiratory fitness.
Why exercise alone is a poor weight-loss strategy
If the goal is purely to lose weight, activity by itself is an inefficient route. Unless someone trains at high volumes, the losses are usually small, and fewer than one person in seven manages a clinically meaningful reduction through exercise alone. The body, in effect, fights back: appetite climbs and metabolism slows, eroding the deficit that training creates.
This is why exercise works best in combination. Adding it to a calorie-reduced diet produces more weight loss and better metabolic results than either approach in isolation. And the composition of that loss matters as much as the total. Eating enough protein and including resistance work helps ensure the weight that goes is fat rather than muscle, preserving the lean tissue that keeps metabolism and strength intact.
Keeping weight off is the harder battle
Losing weight is difficult; not regaining it is harder still, and regain tends to undo the health gains that came with it. Here the evidence points firmly towards higher activity levels, somewhere between 200 and 300 minutes a week, as a marker of people who keep weight off successfully. The catch is that few people sustain that volume.
A more realistic path is to build gradually towards at least 150 minutes a week of moderate-to-vigorous activity, then add more where possible. Even when some weight creeps back, staying active keeps the cardiometabolic benefits in play, which is reason enough to maintain the habit rather than abandon it after a setback.
Where medication and surgery enter the picture
For people whose body mass index is high and for whom lifestyle change has not been enough, obesity medications and bariatric surgery are central options. Both are effective, and both come with real-world limits around cost, availability and side effects. Neither replaces an active lifestyle; the statement frames physical activity as the strategy that should run alongside them.
The newer GLP-1 receptor agonists, including liraglutide, semaglutide and tirzepatide, have transformed what medication can achieve, with some trials approaching the results once seen only after surgery. They work mainly by curbing appetite and slowing the stomach’s emptying, and although side effects are common, they are usually manageable. Beyond weight, liraglutide and semaglutide have been shown to cut major cardiovascular events in certain high-risk groups.
What remains poorly understood is how exercise fits into this newer landscape. Most medication trials simply have not isolated what activity adds, or how the two interact, leaving the ideal exercise prescription for people on these drugs an open question. The issue is sharpened by the fact that a notable share of the weight lost on GLP-1 receptor agonists is lean tissue rather than fat, even if the long-term consequences of that are not yet clear. The handful of studies that do compare medication with and without exercise suggest that adding activity means more fat loss and better fitness, but the field is still waiting for the large, controlled trials that would settle the matter.
Surgery raises related questions. People approaching bariatric procedures tend to be less active to begin with, and there is no agreed playbook for the period beforehand; insurer-mandated pre-surgical activity programmes exist, but the evidence that they change outcomes is thin and inconsistent. Afterwards, the picture is clearer: people who move more lose more weight and fat, hold onto those losses, and gain in fitness and strength, though effects on metabolic risk markers vary and access to structured programmes is frequently lacking.
Turning good intentions into sustained habits
Clinicians are not bystanders in any of this. A widely used framework, the 5A model, gives consultations a useful spine: assess where the person is, advise on the options, agree on goals, assist in pursuing them and arrange follow-up. Worked through properly, each step tends to deepen engagement with both dietary change and activity, making healthy behaviours easier to stick to.
Doing this well means looking past activity levels alone to the psychological, social and medical factors that can stall progress, and gauging how ready and confident someone feels about changing. Counselling tailored to that profile builds motivation and trust, which in turn supports the activity itself. Equipping clinicians to weave physical activity, dietary change and behaviour change into everyday obesity consultations is the focus of practical training such as the College of Contemporary Health’s Obesity Toolbox, a CPD-accredited online short course. Because a short appointment can only do so much, part of the clinician’s job is helping people spot the obstacles in their way, solve them together, and connect with wider support, whether behavioural counselling or a digital programme that keeps them accountable between visits.
Technology is increasingly part of that support. Wearables, apps, text reminders, personalised feedback and self-monitoring all show promise for keeping people moving. The statement is careful, though, to flag the caveats: not everyone has equal access to these tools, the devices vary in how accurately they measure activity, and none of it substitutes for regular reassessment and structured follow-up.
The bottom line for treatment
Physical activity belongs at the heart of comprehensive obesity care, supporting weight loss, helping maintain it and improving health more broadly. Medications and surgery are genuine advances, but exercise adds something they do not fully provide: gains in cardiovascular risk, body composition, fitness and quality of life, many of which arrive independently of any change on the scales.
Delivering that well takes teamwork across clinicians and allied health professionals, and programmes that are not only effective but also affordable and within reach, especially for under-resourced communities where obesity is more common and activity levels lower. Making the wider case for movement, rather than treating it as a weight-loss tool alone, is likely to be what makes obesity treatment hold up over the long run and eases the cardiovascular toll that obesity exacts.
CCH insights:
This study strikes right at the heart of how our understanding of obesity is starting to change – it is not all about body weight and body fat, but about health. Although reducing harmful body fat is an important part of obesity treatment, so is improving cardiometabolic health and other health issues that arise as a result of obesity. And physical activity is a vital tool in delivering these health improvements – helping to reduce blood pressure, regulate blood glucose, reduce cholesterol and improve
muscle mass and function – whether or not it results in weight loss whether or not it results in weight loss. For clinicians looking to put this into practice, CCH’s Obesity Toolbox (1.5 hours, fully online, CPD-accredited) is a quick, practical primer on the essentials of physical activity, dietary change and behaviour change in obesity care – a fast starting point for busy practitioners.
Explore the Obesity Toolbox →
AI Models Identify Hidden Cardiac Arrest Risk in Routine Patient Data
Key Takeaways:
- Researchers have built AI models that analyse electronic health records and electrocardiograms to identify people at elevated risk of sudden cardiac arrest, which kills more than 400,000 Americans each year.
- In a real-world group of nearly 40,000 patients, the combined model correctly flagged 153 of 228 high-risk people who later experienced cardiac arrest, narrowing risk prediction from 1 in 1,000 to 1 in 100.
- The models also surfaced modifiable contributors such as electrolyte disorders, substance use and medication interactions, pointing to practical opportunities for clinicians to intervene.
A new approach to an unpredictable emergency
Researchers have developed artificial intelligence (AI) models capable of analysing electronic health records (EHR) and electrocardiograms to pinpoint people in the general population who face a heightened risk of sudden cardiac arrest. The condition is responsible for more than 400,000 deaths each year in the United States and carries a survival rate of just 10%, making any tool capable of forecasting it a meaningful step forward.
The work represents a notable advance in anticipating an event that is widely considered difficult, if not impossible, to predict, and which often strikes people who have no previously known heart disease.
“Using artificial intelligence applications and health records data, the prediction of cardiac arrest in the general population is feasible,” said Dr Neal Chatterjee, the study’s lead investigator and a cardiologist at the University of Washington School of Medicine.
The paper was published on 11 May in JACC: Advances, a journal of the American College of Cardiology. Additional co-senior authors are affiliated with Massachusetts General Hospital and the Broad Institute of MIT and Harvard.
How the models were built
The investigation drew on a test population of roughly 1.7 million patients enrolled in a large healthcare system in the United States. The team built three separate AI models, each trained on a distinct dataset. The first, referred to as “EKG-only,” relied solely on electrocardiogram readings. The second, “EHR-only,” weighed 156 clinical features drawn from patients’ health records. The third combined both EKG and EHR data into a single integrated model.
The researchers developed and validated their models across three distinct patient groups.
Training cohort
The models were initially trained using data from 993 people who had experienced out-of-hospital cardiac arrest between 2013 and 2021, alongside 5,479 control patients matched for age and sex who had not. This stage allowed the AI to learn which patterns in EHR entries and EKG readings were linked to a higher risk of cardiac arrest.
Testing cohort
To confirm that the models could reliably distinguish between high- and low-risk indicators, the researchers applied them to a separate group consisting of 463 cardiac arrest cases from 2022 to 2023 and 2,979 control patients. The risk associations identified in this testing group closely mirrored those established during training.
Real-world cohort
The final stage involved 39,911 people who had received EKGs during 2021, regardless of their health status. The researchers examined the records of those within this group who went on to experience cardiac arrest over the following two years, assessing how closely their profiles aligned with the risk patterns identified by the models.
Within this real-world group, the combined EHR-EKG model accurately predicted 153 of 228 people who were classified as high-risk and who later went on to experience a cardiac arrest.
Bringing theoretical risk into focus
The shift in predictive precision is one of the study’s most striking outcomes.
“With these models, we’re able to enrich risk prediction from about 1 in 1,000 down to 1 in 100,” Chatterjee said. “If your doctor were to tell you that your risk of cardiac arrest is 1 in 100, that would catch your attention. We’re bringing a theoretical risk into focus.”
Another encouraging finding concerned the performance of the EKG-based model on its own. AI-enhanced analysis of electrocardiograms alone demonstrated strong predictive ability, only modestly behind the two models that drew on EHR data.
“The 12-lead EKG is a low-cost tool that might stratify patients’ risk for cardiac arrest in any community around the world,” Chatterjee said.
Risk factors beyond traditional cardiology
The study also surfaced risk factors that lie outside the conventional cardiovascular picture. Contributors flagged by the models included electrolyte disorders, substance use and interactions between medications, all of which are often addressable through clinical attention.
“We show some relatively low hanging fruit … modifiable risk factors,” Chatterjee noted. “A model that flags a patient as high-risk might prompt somebody taking care of a patient to review their medical history and their medications.”
Open questions for clinical practice
While the results demonstrate that predicting cardiac arrest risk at the population level is achievable, Chatterjee was careful to note that the next stage of inquiry involves working out what clinicians should actually do once a patient is flagged.
“We need to figure out which follow-on studies to pursue to understand what we do with this patient information. What screening, what surveillance, what intervention is warranted?”
Limitations of the study
Several constraints temper the findings. All of the data was drawn from a single healthcare system, leaving open the question of whether the models would perform similarly across populations with different demographic profiles or patterns of care. The real-world group was also restricted to people who had received an EKG, and these individuals may differ in important ways from those who had not undergone such testing. In addition, the AI-enhanced interpretations of EKGs could reflect biases tied to demographics or to the way care is delivered.
Funding and support
The research received support from the National Institutes of Health (K23HL169839, R01 HL160003, R01 HL168889, K24 HL153669, R01HL092577, R01HL157635), the American Heart Association (23CDA1050571, 961045), the European Union (MAESTRIA 965286) and the Foundation Leducq (24CVD01). Chatterjee is supported through a philanthropic donation from Kevin and Ann Harrang and through the John and Cookie Laughlin Endowed Professorship.
Source: UW Medicine
Heart Disease Now Affects Nearly Half of US Adults, as Obesity and Diabetes Continue to Rise
Key Takeaways:
- Nearly half of adults in the United States are now living with cardiovascular disease, with prevalence projected to rise further as obesity, diabetes, and hypertension increase.
- New data highlight worsening cardiometabolic risk factors, including declining blood pressure and glycaemic control, alongside rising concerns around sleep health, physical inactivity, and nicotine exposure.
- The report underscores the urgent need for prevention-focused, equitable approaches to cardiovascular, kidney, and metabolic health across the life course.
A comprehensive annual snapshot of cardiovascular health
The 2026 Heart Disease and Stroke Statistics Report from the American Heart Association, published in the journal Circulation, provides an updated and wide-ranging overview of heart disease, stroke, and cardiovascular risk factors. Updated annually, the report integrates the most recent data, adds new thematic chapters, and removes outdated material to reflect the evolving cardiovascular health landscape.
The latest edition draws on a year-long collaborative effort involving volunteers, scientists, clinicians, government representatives, and AHA staff. It includes an expanded chapter on nicotine and tobacco use and exposure, alongside a new chapter focused on cardiovascular, kidney, and metabolic (CKM) syndrome. Together, these additions reflect growing recognition of the interconnected nature of cardiometabolic risk factors and their cumulative impact on population health.
Cardiovascular health trajectories and nicotine exposure
According to the report, several major cardiometabolic conditions are projected to rise substantially by 2050 among adults in the United States. Hypertension prevalence is expected to reach 61 percent, diabetes 26.8 percent, and obesity 60.6 percent. In contrast, hypercholesterolaemia is the only major risk factor projected to decline, falling from 45 percent to 24 percent.
Most core health behaviours are projected to worsen over time. An important exception is sleep, where inadequate sleep duration is expected to increase. Evidence from a 2010 to 2022 meta-analysis showed that people with ideal cardiovascular health experienced a 74 percent lower risk of cardiovascular disease events compared with those with poor cardiovascular health.
Nicotine exposure remains a major concern. People who smoke have a mortality risk three times higher than those who have never smoked. While smoking prevalence among adults in the United States has declined, the use of e-cigarettes has increased sharply. National Health Interview Survey data from 2017 to 2023 indicate that e-cigarette use has quadrupled over this period.
Physical activity and sleep health
Levels of physical activity remain suboptimal across age groups and regions. Only one in five children and adolescents aged 6 to 17 years achieved at least 60 minutes of daily physical activity. Globally, around one-third of adults across 163 countries did not meet recommended activity levels.
Sleep health has emerged as a significant cardiovascular risk factor. Data from the National Health and Nutrition Examination Survey covering 2017 to 2020 showed that 30 percent of adults experienced at least one hour of sleep debt, defined as the difference between sleep duration on workdays and free days. Observational analyses linked poor sleep with higher odds of type 2 diabetes, hypercholesterolaemia, and hypertension.
Obesity, lipids, blood pressure, and diabetes
Obesity prevalence continues to rise among both children and adults in the United States. Estimates from the Global Burden of Diseases, Injuries, and Risk Factors study indicated that in 2021 more than 15 million children aged 5 to 14 years, 21 million young people aged 15 to 24 years, and 172 million adults aged 25 years or older were living with overweight or obesity.
While the prevalence of high total cholesterol has decreased, low-density lipoprotein cholesterol remains a major driver of cardiovascular mortality. Global data from 2021 attributed a cardiovascular disease mortality rate of 43.7 per 100,000 people to elevated low-density lipoprotein cholesterol.
Hypertension prevalence remained broadly stable between 2013 and 2023. However, blood pressure control worsened, declining from 54.1 percent in 2013 to 2014 to 48.3 percent in 2017 to 2020. Some improvement was observed among non-Hispanic Black adults between 2017 to 2020 and 2021 to 2023.
Diabetes prevalence also remains high. Between 2021 and 2023, an estimated 29.5 million adults had diagnosed diabetes, 96 million had prediabetes, and 9.6 million were living with undiagnosed diabetes. Among people with diagnosed diabetes, glycated haemoglobin levels increased significantly from 2017 to 2020 and again from 2021 to 2023, while overall glycaemic control rates declined.
Kidney disease, CKM syndrome, and pregnancy outcomes
The burden of kidney disease has risen markedly over the past two decades. The prevalence of end-stage kidney disease nearly doubled between 2002 and 2019, before stabilising in subsequent years. Across 114 cohort studies, both albuminuria and reduced kidney function were consistently associated with increased risk of kidney failure and mortality.
Data from NHANES between 2011 and 2020 suggest that approximately 90 percent of adults in the United States were in stage 1 or higher of CKM syndrome. People from underrepresented ethnic and racial groups experienced a disproportionately higher burden of advanced CKM stages. More advanced stages were strongly associated with increased cardiovascular disease mortality.
The report also highlights links between cardiometabolic health and pregnancy outcomes. In Japan, pregnant individuals with higher healthy lifestyle scores before pregnancy had around a one-third lower risk of adverse pregnancy outcomes compared with those with the lowest scores. Although maternal mortality rates declined across all ethnic and racial groups between 2021 and 2022, persistent disparities remain.
Cardiovascular disease, stroke, dementia, and congenital conditions
Overall cardiovascular disease prevalence reached nearly 49 percent among adults aged 20 years or older, based on NHANES data from 2021 to 2023. Prevalence increased with age in both women and men. At the population level, stronger adherence to healthy dietary patterns was associated with lower cardiovascular disease risk.
Stroke incidence declined between 1993 and 2015 among both Black and White adults, although rates remained consistently higher in Black populations. Dementia prevalence among older adults decreased between 2011 and 2021, though findings varied depending on study design and population. Evidence from selected intervention studies suggested that high-intensity training may help slow cognitive decline.
Congenital cardiovascular defects were estimated to affect around 1 in 80 babies in high-income regions of North America. Globally, survival into adulthood among people born with congenital heart disease improved substantially between 1990 and 2019. Population-based analyses linked limited prenatal care, neighbourhood deprivation, and air pollution to increased risk of heart defects, poorer outcomes, and delayed diagnosis.
Heart rhythm disorders, cardiac arrest, and heart failure
Heart rhythm disorders and heart failure continue to contribute significantly to cardiovascular morbidity. Atrial fibrillation affected an estimated 10.55 million adults in the United States, representing 4.48 percent of the adult population.
Patterns of cardiac arrest have also shifted. Opioid-related out-of-hospital cardiac arrests accounted for less than 1 percent of cases in 2000 but rose to between 7 percent and 14 percent by 2023. Coronary heart disease prevalence was estimated at 5.2 percent among adults aged 20 years or older between 2021 and 2023. Over the same period, heart failure prevalence increased from 6.7 million people in 2017 to 2020 to 7.7 million in 2021 to 2023.
A growing burden with global implications
Taken together, the 2026 Heart Disease and Stroke Statistics Report paints a picture of a growing cardiovascular disease burden affecting around half of the adult population. Despite major advances in diagnostics, prevention strategies, and treatment options, ageing populations, widening health inequalities, and rising cardiometabolic risk factors continue to place increasing pressure on healthcare systems.
The report emphasises the need for coordinated, prevention-led approaches that prioritise early intervention and equitable access to care. Without sustained action across policy, healthcare, and community settings, current trends are likely to continue, with profound long-term health and economic consequences.
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Exercise Shown to Reduce Artery Hardening After Weight Loss in Adults With Obesity
Key Takeaways:
- Regular exercise after weight loss significantly reduces inflammation and improves blood vessel health in adults living with obesity.
- The GLP-1 receptor agonist liraglutide helped participants maintain weight but did not show the same protective effects against artery hardening.
- Researchers emphasise exercise as an essential factor for maintaining cardiovascular health after weight reduction.
Exercise and heart health after weight loss
Maintaining weight loss through regular exercise, rather than relying solely on the glucagon-like peptide-1 receptor agonist (GLP-1RA) liraglutide, appears to protect against atherosclerosis in adults living with obesity, according to new research from the University of Copenhagen. Atherosclerosis—hardening and narrowing of the arteries due to inflammation and fat deposits—is a major underlying cause of cardiovascular disease (CVD).
The findings were presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) 2025 in Vienna (15–19 September).
“Our findings reveal that regular exercise is crucial to helping people living with obesity get the full cardiovascular benefits after a substantial weight loss,” said Dr Rasmus Sandsdal, lead author of the study from the University of Copenhagen, Denmark.
Understanding the risk
Cardiovascular disease remains the leading cause of death globally. It often begins with atherosclerosis, in which chronic inflammation and lipid accumulation cause the arteries to stiffen and narrow. If left unchecked, these plaques can rupture and trigger life-threatening events such as heart attacks and strokes.
Obesity contributes to chronic low-grade inflammation and endothelial dysfunction—a condition in which blood vessels lose their ability to contract and relax properly—both of which accelerate atherosclerosis.
While both exercise and GLP-1RAs are known to lower cardiovascular event risk in people with obesity, their specific effects on the development of atherosclerosis during weight loss maintenance have remained unclear—until now.
The study design
The Danish research team conducted a randomised placebo-controlled trial involving 215 adults aged 18–65 years (63% female) living with obesity (BMI 32–43 kg/m²) but without diabetes or other serious chronic conditions.
All participants began an eight-week low-calorie diet (800 kcal per day) using the Cambridge Weight Plan. Of these, 195 participants who achieved at least a 5% reduction in body weight (average loss of 12% or 13.1 kg) entered a one-year maintenance phase. They were randomly assigned to one of four groups:
- Exercise (150 minutes/week of moderate-to-vigorous activity) plus placebo
- Liraglutide treatment (3.0 mg per day)
- Exercise combined with liraglutide
- Placebo only
Researchers measured several key biomarkers at three points—before dieting, at the start of weight maintenance, and after one year. These included inflammatory markers (interleukin-6 [IL-6] and interferon-γ [IFN-γ]), endothelial function markers (intercellular adhesion molecule [ICAM-1], vascular adhesion molecule [VCAM-1], and tissue plasminogen activator [tPA]), and carotid artery intima-media thickness [cIMT], an indicator of arterial wall health measured by ultrasound.
Exercise reduced inflammation and improved arterial health
After one year, participants in both the exercise and liraglutide groups successfully maintained their weight loss. However, significant differences emerged in their cardiovascular health profiles.
Those who exercised—whether or not they also received liraglutide—had notably lower levels of inflammatory biomarkers compared with non-exercising participants. On average, IL-6 levels were 21% lower, and IFN-γ levels were 27% lower.
Exercise also had a favourable effect on endothelial function, reflected in a 6% reduction in VCAM-1, 8% reduction in ICAM-1, and 12% reduction in tPA compared to those who did not exercise. Moreover, carotid artery thickness decreased by an average of 0.024 mm, indicating reduced arterial hardening.
In contrast, treatment with liraglutide alone did not yield any measurable improvements in inflammatory or endothelial biomarkers, nor did it affect carotid artery thickness.
“Regular exercise seems to confer a protective effect against the development of atherosclerosis in people trying to maintain weight loss,” said Dr Sandsdal. “Since both exercise and GLP-1RA treatment were successful at keeping weight off, it seems that exercise plays an important role in mitigating cardiovascular risk factors in a weight-independent manner.”
Implications for long-term health
Exercise offers multiple benefits beyond weight control, including improvements in body composition, cardiorespiratory fitness, and metabolic health. Together, these contribute to better long-term cardiovascular outcomes.
“The most important message from our findings is that, for those trying to maintain weight loss, exercise is crucial in improving long-term health,” said Professor Signe Sørensen Torekov, corresponding author from the University of Copenhagen. “Given the substantial societal and economic costs of obesity-related cardiovascular disease, these findings underscore regular exercise as a critical component of weight management and heart health.”
Study limitations and future research
The authors acknowledged several limitations. The study’s sample size was relatively small, and adherence to structured exercise in real-world conditions may be lower than in a supervised trial setting.
Future studies, they suggested, should explore longer-term interventions and evaluate newer GLP-1 receptor agonists—potentially more potent than liraglutide—in combination with consistent exercise to assess whether similar or enhanced cardiovascular benefits can be achieved.
CCH insight:
We have long known that exercise is important for cardiovascular health, so the results of this study should not be a surprise – exercise provides cardiovascular benefits whether or not you are taking a GLP-1 medication. It is also important to remember that GLP-1 receptor agonists are meant to be taken as an adjunct to a healthy diet and lifestyle, including exercise. This is not just about weight management, but also about maximising health benefits and minimising the risk of developing diseases associated with obesity – such as cardiovascular disease.
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