Scientists Assess How Cardiovascular Risks in Obesity Have Changed Over the Past 30 Years

Over the past three decades, differences in blood pressure and "bad" cholesterol levels between older adults with obesity and their normal-weight peers have significantly narrowed, and in some countries, have practically disappeared. This is the conclusion reached by an international team of researchers who published their findings in The Lancet.

The authors believe the main explanation for this trend is the widespread use of cholesterol-lowering drugs, primarily statins, as well as medications for treating arterial hypertension.

Thanks to these agents, the cardiovascular risk for many individuals over the age of 40 with obesity has approached the levels seen in people with a normal body mass index (BMI).

Obesity has long been considered one of the primary risk factors for cardiovascular disease. It contributes to elevated blood pressure and increased levels of atherogenic cholesterol, thereby raising the likelihood of myocardial infarction, stroke, and heart failure. However, until now, there has been little data on how these metrics have changed in people with obesity over an extended period.

For the study, scientists analyzed data from 110 medical databases covering nearly one million people. The analysis included information collected between 1990 and 2024 across seven high-income countries: England, the USA, Japan, South Korea, Taiwan, Thailand, and Finland.

It was revealed that in the 1990s, individuals with obesity in almost all countries had higher blood pressure and non-HDL cholesterol levels—the so-called "bad" cholesterol, which is considered one of the most critical risk factors for atherosclerosis.

However, in the subsequent decades, the situation began to change. In most countries, particularly in England and the USA, blood pressure and "bad" cholesterol levels decreased substantially faster among individuals with obesity and overweight than among those with a normal BMI. As a result, the disparities between these groups gradually diminished.

The most pronounced changes were observed among individuals aged 60–79. By the end of the observation period, older residents of England and the USA with obesity, especially severe obesity, frequently presented with identical or even lower blood pressure and atherogenic cholesterol levels than their normal-weight counterparts of the same age.

Researchers believe that the primary driver behind this convergence is the more proactive prescription of drug therapy to individuals with obesity.

Over the past 30 years, it is this specific cohort that has much more frequently received cholesterol- and blood pressure-lowering medications. The gap was particularly striking among older men. For instance, in England and the USA by the early 2020s, cholesterol-lowering drugs were taken by 70–72% of older men with severe obesity (a BMI of 35 and above), compared to just 40–48% of men of the same age with a normal BMI.

The authors emphasize that the widespread availability of statins and other cardiovascular drugs has likely become one of the most significant achievements of modern preventive medicine.

At the same time, the study highlighted an important exception. Among individuals under the age of 40, virtually no such improvement is observed. Differences in blood pressure and cholesterol levels between individuals with obesity and those with normal weight remain substantial in this age group.

According to the researchers, this is due to the fact that young people are much less likely to receive medications for the prevention of cardiovascular diseases. Therefore, experts call for earlier preventive measures, including lifestyle modifications, regular screenings, and, when indicated, the timely initiation of medical treatment.

The authors also noted the limitations of their study. The analysis included only seven economically developed countries; thus, the findings cannot be automatically extrapolated to low- and middle-income nations, where the accessibility of statins and hypertension medications is significantly lower. Furthermore, the study did not allow for an evaluation of the impact of different drug dosages, as the prescription data was incomplete.