Treatments Have Leveled Cholesterol and Blood Pressure in Adults Over 40 With Obesity, Landmark Lancet Study Finds

A sweeping observational study published in The Lancet has found that blood pressure and cholesterol levels in adults over 40 with obesity (搜索)搜索该疾病 have become increasingly similar to those of people with normal body weight, a shift driven primarily by the widespread use of antihypertensive and lipid-lowering medications over the past three decades.

The analysis, led by researchers including Prof Majid Ezzati of Imperial College London查看公司主页 and Dr Francesco Zaccardi of the University of Leicester查看公司主页, pooled data from 110 health surveys encompassing nearly one million participants across seven high-income countries—England, the United States, Japan, South Korea, Taiwan, Thailand, and Finland—spanning the years 1990 to 2024.

“This article presents a sound design for a retrospective study and is of good quality. Suffice it to say that it presents a sample size of almost one million patients, 110 surveys, and data from various countries on different continents,” noted one independent expert commenting on the research.

Pharmacological progress narrows the gap

The main finding—that the blood pressure and cholesterol profiles of older adults with obesity (搜索)搜索该疾病 increasingly mirror those of normal-weight individuals—is consistent with what researchers already understood about the advancement of pharmacological treatment in recent decades. While not unexpected, the study provides a useful quantification of the phenomenon at an unprecedented scale.

“It's logical that obese patients treated with lipid-lowering and antihypertensive drugs (搜索)搜索该药品 tend to experience a decrease in their blood pressure and lipid levels. If these results didn't follow this pattern, we would be applying ineffective pharmacological treatments and misleading the patient,” one commentator observed.

The study suggests that healthcare systems in industrialized nations have made meaningful strides in cardiovascular risk factor management. “Obese people in industrialized countries with available medical treatments have better quality of life and they will probably live longer. This idea is definitely worth taking to heart, to appreciate how far we've come,” the same expert added.

Obesity (搜索)搜索该疾病 remains a major clinical problem

Despite the encouraging trends, researchers and independent commentators alike emphasized that the findings should not be interpreted as evidence that obesity (搜索)搜索该疾病 has become benign.

“We must emphasize that obesity (搜索)搜索该疾病 has not become benign or controllable, because treating obesity means treating the root cause of the problem, and the root cause is metabolic and adiposopathy. It's not just about treating the consequences of obesity,” one expert cautioned.

The study measured only two of the many mechanisms by which obesity (搜索)搜索该疾病 influences health—blood pressure and cholesterol—and did not analyze inflammation, insulin resistance, diabetes, joint problems, or certain types of cancer, all of which are linked to excess weight. “Obesity is a much greater risk factor than hypertension (搜索)搜索该疾病 and cholesterol alone,” a commentator stressed, noting that the study failed to include diabetes, low-grade chronic inflammation, and cancer among its endpoints.

Furthermore, the improvement was observed only in people over 40. In younger people with obesity (搜索)搜索该疾病, metabolic risk remains significantly higher than in those of normal weight, underscoring the importance of early intervention.

Methodological considerations and limitations

The study's authors were commended for their honesty in acknowledging several limitations. The use of BMI to define obesity (搜索)搜索该疾病 is a key constraint, as health professionals have long noted that this measure does not distinguish between fat and muscle, nor does it indicate fat distribution—which is clinically the most important factor. The study also did not include any data on participants' diets, making it impossible to determine how much of the observed improvement is attributable to medications versus other unmeasured factors.

Additionally, the same BMI thresholds were applied across all countries, even though Asian populations tend to have more body fat and higher cardiometabolic risk at the same BMI compared to Western populations. Cases of severe obesity (搜索)搜索该疾病 in the Asian countries included were so rare—less than 2–3% of the population—that many estimates had to be excluded or were deemed unreliable.

A potential survival bias also complicates interpretation: people with severe obesity (搜索)搜索该疾病 and poorer metabolic health may die earlier and thus not be captured in surveys of older adults. This means some of the observed improvement could reflect a selection effect, where survivors represent the healthiest segment within the obesity group.

The study recorded only whether participants were taking medication, not the intensity or type of treatment, making estimates of improvement approximate rather than directly causal.

Implications for clinical practice

The findings reinforce the message that timely pharmacological intervention can substantially mitigate certain cardiovascular risk factors in people with obesity (搜索)搜索该疾病, but they do not diminish the importance of addressing obesity itself. “Time is of the essence when treating obesity and its cardiovascular complications; time is of the essence for prevention and for initiating the correct treatment for this chronic and complex disease,” one expert concluded.

“Treating obesity (搜索)搜索该疾病 means addressing each and every cardiovascular risk factor, from its metabolic origin, without neglecting any of them. It's a treatment we call comprehensive, and we must be aware that it's crucial to address the root cause and prevent it in its early stages.”