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A study published in The Lancet looks at blood pressure and cholesterol in adults with obesity compared to adults with normal BMI.
Prof Robert Storey, Professor of Cardiology, University of Sheffield, said:
“This analysis of data from studies in many countries, including England, was performed by experts in the field of cardiovascular disease prevention and is of high quality. It is well known that obesity is associated with harmful increases in blood pressure and cholesterol levels. The findings of the study suggest that recognition of this fact has led to individuals with obesity being increasingly prescribed medication to help control blood pressure and lower cholesterol levels. This will help to reduce some, but not all, of the risk of heart attacks and strokes in people with obesity. However, it does raise concern that some individuals may not be aware that they can have an increased risk of heart attack related to high cholesterol and high blood pressure, as well as other lifestyle risks, even though they are not overweight. The study also shows very limited use of cheap medications in people under the age of 40, even though heart attacks and strokes can occur in people in their 20s and 30s related to high cholesterol and blood pressure. This requires further research to establish the benefits of early use of preventive medication in younger adults who have inherited a high risk of cardiovascular disease.”
Dr Marie Spreckley, research programme manager and researcher, Prevention of Diabetes and Related Metabolic Disorders in High Risk Groups, University of Cambridge, said:
“This is a large, high-quality observational study that combines data from 110 nationally representative surveys, including almost one million adults across seven industrialised countries over more than three decades. 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. Overall, the press release accurately reflects the study and appropriately communicates both its strengths and its limitations.
“The study provides robust evidence that, in several of the countries studied, the gap in blood pressure and non-HDL cholesterol between adults aged over 40 years with obesity and those with a normal BMI has narrowed substantially over time. This convergence occurred alongside markedly greater use of antihypertensive and lipid-lowering medication among people with obesity, which is consistent with, but does not establish, the authors’ interpretation that improved detection and treatment of cardiovascular risk factors contributed to these trends.
“As with any observational study, however, the findings cannot establish cause and effect. 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. In addition, the analysis was limited to seven industrialised 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. The persistence of lower HDL cholesterol among people with obesity also highlights that improvements in some cardiometabolic risk factors do not equate to complete normalisation of metabolic health.
“Overall, the authors’ conclusions are appropriately cautious and well supported by the data. The study provides important evidence that advances in cardiovascular prevention and treatment may have reduced some of the cardiovascular consequences of obesity among middle-aged and older adults, while also highlighting that younger adults with obesity continue to experience substantially higher metabolic risk.”
Prof Naveed Sattar, Professor of Cardiometabolic Medicine/Honorary Consultant, University of Glasgow, said:
“This is an important paper drawing on data from many countries worldwide. It uses data gathered from multiple sources and work appears generally well done, despite some limitations of missing data. The findings provide reassuring evidence that people living with obesity – particularly older adults – are increasingly receiving appropriate lipid-lowering and blood pressure therapies, although there remains scope to be more proactive in younger individuals with obesity who face many years of future risk. However, while these treatments are highly effective at reducing atherosclerotic cardiovascular events, they do not address, or only minimally address, many of the broader health consequences of obesity including non-atherosclerotic events (e.g. heart failure, atrial fibrillation) which are much more closely linked to obesity than heart attacks or strokes. As obesity rates continue to rise, we are also seeing increasing burdens of type 2 diabetes, chronic kidney disease, heart failure, several cancers, and other obesity-related complications (e.g. sleep apnoea, osteoarthritis, liver conditions etc) that are generally not prevented by statins or blood pressure medications alone. In addition, obesity also impacts people happiness, mobility, mental health and social independence.
“My key message in general therefore is that controlling cholesterol and blood pressure, while essential, is not enough anymore. 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. This concern is consistent with emerging clinical experience and recent evidence, including our paper “Treating chronic diseases without tackling excess adiposity promotes multimorbidity.” https://pubmed.ncbi.nlm.nih.gov/36460014/
“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 life years. Statins and blood pressure treatments are important parts of the solution, but they are now far from the whole solution.”
‘Metabolic traits in obesity and normal BMI in industrialised countries: a multi-country analysis of national population based studies’ by Ysé d’Ailhaud de Brisis et al. was published in the Lancet at 23:30 UK time on Wednesday 1 July 2026.
Declared interests
Prof Robert Storey: “I don’t have relevant disclosures related to these comments.”
Dr Marie Spreckley: “Dr Marie Spreckley is a Postdoctoral Researcher at the University of Cambridge whose research focuses on obesity and weight management. She has no personal financial interests, consultancy roles, advisory positions, speaker fees, stock ownership or honoraria from companies developing or manufacturing obesity medications.”
Prof Naveed Sattar: “NS has consulted for and/or received speaker honoraria from Abbott Laboratories, AbbVie, Afimmune, Amgen, AstraZeneca, Boehringer Ingelheim, Carmot Therapeutics, Eli Lilly, Gan & Lee, GlaxoSmithKline, Hanmi Pharmaceuticals, Janssen, Kailera, Mass Medicines, Menarini-Ricerche, Merck Sharp & Dohme, Metsera, Novartis, Novo Nordisk, Pfizer, Regeneron, Roche, Sanofi, UCB Pharma and Verdiva Bio; and received grant support paid to his University from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche. No shares in any medical areas.”
This Roundup was accompanied by an SMC Briefing.