Mixed
Achieving a BMI <25 kg/m2 is associated with a significantly greater reduction in predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk compared to maintaining a BMI ≥25 kg/m2, regardless of whether the weight loss is achieved via tirzepatide or placebo.
If you have obesity or overweight, aiming for a BMI below 25 kg/m2 may offer greater protection against heart disease and stroke than stopping at a smaller weight loss. This target is increasingly achievable with modern medications like tirzepatide, which help achieve significant weight reduction. While current guidelines suggest 5-15% weight loss, this analysis indicates that reaching a 'normal' BMI might provide additional cardiovascular benefits, particularly for those with existing risk factors like high blood pressure or NAFLD.
After adjusting for baseline covariates, relative to baseline, participants achieving BMI <25 kg/m2 had a significantly greater percent reduction in predicted ASCVD risk (39.4% vs 10.6%, P < 0.001) compared to the BMI ≥25 kg/m2 group.
Why this rating
Post hoc analysis of pooled RCTs; uses a validated prediction model (ACC/AHA PCE) but relies on predicted rather than observed hard clinical events.
Source
Achieving BMI <25 kg/m2 was associated with reduced predicted risk of atherosclerotic cardiovascular disease in people with obesity or overweight on tirzepatide or placebo: a post hoc analysis of SURMOUNT-1, -3, and -CN
Lixin Guo et al. · EClinicalMedicine · 2025
DOI 10.1016/j.eclinm.2025.103722
Related findings · Mixed
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