1 in 15 People at a “Healthy” Weight Have Cardiovascular Disease: Why BMI Doesn’t Tell the Full Story

Expert warns you can have a “healthy” BMI and still develop cardiovascular disease

A hidden blood protein that most GPs never test for could be putting millions of apparently healthy people at serious risk of heart attack and stroke, a health expert has warned. 

Dr Asim Naqvi, General Practitioner at The Forbury Clinic, says that some markers of cardiovascular health like lipoprotein(a) have no connection to body weight or body mass index (BMI). Therefore, size alone cannot determine whether a person is healthy. Those whose weight falls within a 'normal' BMI (18.5–24.9) can still have elevated cholesterol levels, elevated blood sugar and genetic predispositions to heart disease that go undetected for years.

Feeling Healthy is Not Always the Full Picture

'Feeling well' is of course the best possible scenario, but there might be more to what we feel and see on a daily basis. While this warning is not meant to drive fear, it's important to remind everyone that routine checks should never be skipped, and that a person who feels and looks healthy should still make sure to go in at least once a year. In fact, BMI and weight are just two among many indicators of health, and not always the most telling ones. It's possible for individuals who are active and whose standard indicators are normal to have their blood work tell a different story. A UK Biobank Cohort Study found that around one in 15 adults with a normal BMI have cardiovascular disease, highlighting why regular checks remain important regardless of size.

Key Blood Markers to Watch

When you get a blood test, doctors look at specific markers to assess your overall health. Some of these markers, such as LDL cholesterol, triglycerides, HbA1c and lipoprotein(a), can give a clear indication of your cardiovascular health, and can sit outside a safe range regardless of a person's size. 

"Lipoprotein(a) in particular is a blood protein that is largely governed by genetics, meaning diet and exercise have little effect on it, and the only way to know your level is through a specific blood test", Dr Naqvi highlights. "Moreover, this protein is one of the most under-screened cardiovascular risk factors in the UK, and many GPs do not routinely test for it, which means that patients aren't even aware it exists until something goes wrong".

Why Family History Matters

Family history, therefore, plays a key role when it comes to the possibility of a heart condition: if a parent, sibling, or grandparent has experienced a heart attack or a stroke at a relatively young age, that history should prompt earlier and more regular testing, regardless of the individual's own weight or lifestyle habits.

The ideal scenario would be for adults to ask for a full lipid panel as part of their routine health review, and if your family has a relevant medical history, to push for a lipoprotein(a) test.

The Importance of Monitoring Blood Pressure

Blood pressure monitoring is another step that is widely underestimated despite it being extremely accessible and straightforward. High blood pressure often has no symptoms at all, and it is possible to feel well while having readings that are putting real strain on your heart.

Checking your blood pressure at least once a year can help prevent heart attacks, strokes, peripheral artery disease, and kidney disease.

Lifestyle Factors that Still Matter

Beyond blood tests and monitoring, lifestyle factors such as diet, exercise, and emotional wellbeing remain key contributors to overall health. Regular physical activity does more than manage weight; it keeps LDL cholesterol lower and triglycerides in check, and it reduces the risk of heart and circulatory diseases by up to 35%. Moreover, it increases dopamine and serotonin levels, which helps boost mood and motivation. 

At the same time, making sure your stress levels are under control is vital: chronic stress raises cortisol levels, which over time can drive up blood pressure and contribute to inflammation.

Smoking and Cardiovascular Damage

Smoking is among the most significant cardiovascular risk factors, and is also among the easiest to remove from the picture. Even in people who are healthy by traditional standards, smoking causes direct damage to blood vessels and accelerates the build-up of arterial plaque.

While people often think of smoking as a lung issue only, the cardiovascular damage is just as serious, and in many cases, it is happening well before any visible symptoms appear.

Looking Beyond Visible Signs of Health

Periodic blood testing should not be done only by people who are overweight, are feeling poorly, or already have a diagnosis. It is imperative for anyone to have an accurate picture of where they stand and which next steps to take.

A blood test is one of the most straightforward ways to understand your heart risks. It is not about anxiety or hypochondria; it is about having the information you need to take care of yourself properly.

Dr Naqvi recommends, "If your father had a heart attack before 55 or your mother before 65, you should be asking your GP for a lipoprotein(a) test at your next appointment, not waiting for symptoms. From there, a clearer plan around monitoring, lifestyle adjustments and, if needed, medical intervention can be put in place".

For more information: https://theforburyclinic.co.uk/