The greater availability and use of medicines is the likely driving force behind levelling of cholesterol blood pressure levels in wealthier countries, study concludes
Adults over-40 and living with obesity in wealthier countries now have the blood pressure and unhealthy cholesterol levels approaching, or healthier than, people with a normal BMI, a major new study suggests.
In a paper published in The Lancet, researchers pointed to the availability and intense use of cholesterol-lowering and blood pressure medications as the driving force behind the trend, which is a significant shift from patterns seen just 30 years ago.
For adults under 40 years old, the study found little change in the gap between blood pressure and unhealthy cholesterol levels in people with obesity and those with normal BMI likely because young adults rarely receive cholesterol or blood pressure medication regardless of their BMI.
The researchers said these findings suggest the cardiovascular risks associated with obesity in some countries have been reduced in older adults. However they highlighted other risks associated with obesity – such as diabetes, kidney and liver diseases, and cancers – remain.
“Our study suggests that, in high-income countries, taking medication to lower blood pressure and cholesterol has helped middle-aged and older adults lower their cardiovascular risk to levels that are similar to people with normal BMI,” said Prof Majid Ezzati from the School of Public Health at Imperial College London.
“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.”
The study analysed data on blood pressure and cholesterol in people with obesity, overweight, and normal BMI from 110 health datasets, including almost one million participants from 1990 to 2024 in seven high-income countries: England, the USA, Japan, South Korea, Taiwan, Thailand and Finland.
The study found that in the 1990s adults with obesity generally had higher blood pressure and high-density lipoprotein (non-HDL) cholesterol levels than people with a normal BMI.
However, since then, in the majority of the seven countries studied including England and the USA, blood pressure and unhealthy cholesterol fell more steeply among overweight and obese adults aged 40-79 than among those with normal BMI, narrowing the gap over time. The exceptions were Taiwan and Thailand, which did not see this convergence as universally as other countries.
The findings were most striking in older adults (60–79 years old). In England and the USA, older adults with obesity, and especially with severe obesity, had similar or even lower blood pressure and unhealthy cholesterol levels at the end of the study period than older adults with normal BMI.
The findings run in parallel with rising levels of use of cholesterol-lowering drugs (such as a statin) and blood pressure medication.
However, among adults under 40, the study suggests little or no narrowing of the gap in blood pressure or cholesterol between those with obesity and those with a normal BMI. The data also suggests that use of cholesterol-lowering and blood pressure medication is low for this age group, adding further evidence that medication is the driver of the gap reduction in older adults.
Co-author Ysé d’Ailhaud de Brisis 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.”
Read the study: Metabolic traits in obesity and normal BMI in industrialised countries: a multi-country analysis of national population-based studies – The Lancet.