Yes. Being only slightly overweight can still carry a serious heart disease risk, because the real driver is not your BMI number on its own but what is happening in your blood. Research presented at the European Association for the Study of Diabetes (EASD) 2026 annual meeting in Milan found that about half of adults with a BMI of 25 to 26.9 had either high remnant cholesterol or persistent low-grade inflammation, and their coronary heart disease risk was similar to that of people who qualify for weight-loss jabs. If your weight sits just above the healthy range, asking your doctor about these two blood markers is a practical next step.
What the Danish study actually found
The analysis, led by Dr Karen Hvid of Copenhagen University Hospital in Herlev, Denmark, pooled data from 313,145 adults in two long-running population studies: the UK Biobank and the Copenhagen General Population Study. Everyone included had a BMI of 25 or above, none had coronary heart disease or diabetes at the start, and the median age was 58 with roughly half the group women. Participants were followed for more than ten years, some for as long as 18, during which 23,134 developed coronary heart disease, defined as a diagnosis, a heart attack, a procedure to restore blood flow to the heart such as bypass surgery or stenting, or cardiovascular death.
The researchers then compared the participants who meet today’s criteria for GLP-1 weight-loss drugs with those who do not. Semaglutide and tirzepatide are approved for weight management in adults with a BMI of 30 or above, or a BMI of 27 or above plus at least one weight-related health condition such as unhealthy cholesterol levels, high blood pressure, type 2 diabetes or previous cardiovascular disease. That leaves adults with a BMI of 25 to 26.9 below the threshold, even though they sit inside the overweight range.
More than 90 per cent of the people who did not meet the current treatment criteria had a BMI between 25 and 26.9. Within that band, 44 per cent of the Danish group and 48 per cent of the UK group had high remnant cholesterol, low-grade inflammation, or both. Among those ineligible for the drugs, participants with both markers were 41 per cent (Denmark) and 47 per cent (UK) more likely to develop coronary heart disease than ineligible participants with healthy levels. That excess risk was essentially the same as for the people who do qualify for the drugs, whose risk was 41 per cent and 35 per cent higher respectively. The researchers concluded that clinical trials are now needed to test whether treatment could benefit this additional group.
What is remnant cholesterol?
When your doctor orders a cholesterol panel, you usually hear about LDL, the “bad” cholesterol, and HDL, the “good” kind. Remnant cholesterol is the third member of the family: the cholesterol carried in certain fat-rich particles in the blood that is neither LDL nor HDL. Research from the Copenhagen General Population Study has shown that in adult Danes, levels of remnant cholesterol are just as high as levels of LDL cholesterol, and earlier work from the same group found that remnant cholesterol is at least as critical as LDL for the risk of myocardial infarction and stroke. A 2025 paper in The Lancet Regional Health Europe went further, concluding that elevated remnant cholesterol is a causal risk factor for coronary heart disease, with high body mass index one of its most important drivers.
The uncomfortable detail is that a standard lipid profile does not always spell it out clearly. Remnant cholesterol can be calculated from a routine fasting or non-fasting lipid panel, and it tends to climb as body weight rises. The Danish researchers found that remnant cholesterol levels start rising from around age 20 and keep climbing until about age 60, with overweight and obesity identified as the main cause of the very high levels seen in the population. That means a slightly overweight adult can have deceptively normal LDL while remnant cholesterol quietly keeps their artery risk high.
What is low-grade inflammation, and how do doctors measure it?
Low-grade inflammation is not the kind of inflammation you feel. It is a persistent, low-level activation of the immune system that damages blood vessels over years, and it is common in people carrying excess weight. Doctors can detect it with a high-sensitivity C-reactive protein (hs-CRP) blood test, which measures tiny amounts of a protein the liver makes in response to inflammation. Persistently raised hs-CRP has been linked to a greater chance of developing heart disease, and in the Danish analysis it was the second marker that separated the genuinely low-risk slightly overweight adults from those whose heart risk matched the GLP-1-eligible group.
Neither marker on its own tells the whole story. In the study, having both high remnant cholesterol and low-grade inflammation carried the strongest signal, lifting coronary risk to roughly the level of the people who qualify for weight-loss medication. That is the core message: two cheap, widely available blood measurements can split “just overweight” adults into two groups with very different futures.
Why about half of “just overweight” adults are affected
The overweight range spans BMI 25 to 29.9, so a BMI of 25 to 26.9 is its lower half: noticeably above the healthy range yet comfortably below the BMI 27 threshold where a weight-related condition opens the door to prescription weight-loss treatment. Because eligibility rules lean heavily on the BMI number, someone with a BMI of 26 and quietly elevated remnant cholesterol and inflammation can be classified as low priority, while someone with a BMI of 27 and an extra condition is treated as a candidate for therapy.
The EASD findings suggest that for roughly one in two of these people, the BMI number is giving false reassurance. Their blood tells a different story, and the study’s comparison shows their coronary risk is not mildly raised but comparable to the people medicine has already decided are worth treating. The researchers were careful to say the finding changes nothing about who can get a prescription today, and they called for clinical trials before any extension of the drugs’ indication. But the implication for ordinary check-ups is immediate: the markers worth acting on are already measurable in any clinic.
What to ask your doctor at your next check-up
You do not need to wait for guidelines to catch up before having a useful conversation. If your BMI sits between 25 and 26.9, or even a little higher, consider asking your GP or clinician three questions at your next appointment.
First, can they calculate your remnant cholesterol from your most recent lipid panel? Because it is derived from the standard numbers rather than a separate test, a doctor can work it out from results you may already have. Second, would a high-sensitivity CRP test be appropriate for you, especially if you have a family history of heart disease, borderline blood pressure, or other risk factors? Third, if either marker comes back raised, what changes to diet, activity, or medication does your doctor recommend, and when should the tests be repeated?
None of this replaces the basics. Regular movement, a diet low in saturated fat and refined carbohydrates, not smoking, and keeping blood pressure in range remain the foundation of heart protection. What the Danish data add is precision: for the “just overweight” adult, two specific blood markers can turn a vague worry into a concrete answer, and that answer can change what happens next.
Frequently asked questions
Can being slightly overweight cause heart disease?
Yes. A large Danish analysis presented at EASD 2026 found that adults with a BMI of 25 to 26.9 who had high remnant cholesterol or low-grade inflammation faced coronary heart disease risk comparable to people eligible for GLP-1 weight-loss drugs. The risk comes from the blood markers, not the BMI number alone.
What is remnant cholesterol?
Remnant cholesterol is the cholesterol carried in fat-rich blood particles that is neither LDL nor HDL. Research shows it is a causal risk factor for coronary heart disease, that high body mass index is one of its main drivers, and that it can be calculated from a standard lipid panel.
What blood test shows low-grade inflammation?
A high-sensitivity C-reactive protein (hs-CRP) test detects the low-level immune activation linked to blood vessel damage. Raised hs-CRP, especially alongside high remnant cholesterol, marked the high-risk group in the Danish study.
Should people with a BMI of 25 to 26.9 get these tests?
It is worth discussing with your doctor. The study found about half of people in this BMI band had one or both markers raised, and knowing your levels can guide decisions about lifestyle changes or medication with your clinician.
Sources
- EASD 2026 press summary, reported by News-Medical: new research presented at the EASD annual meeting, Milan, 28 September to 2 October 2026, by Dr Karen Hvid and colleagues, Copenhagen University Hospital. News-Medical report
- Medical Xpress summary of the same EASD 2026 presentation (313,145 participants, BMI 25 to 26.9 analysis). Medical Xpress summary
- Knowridge reporting on the EASD 2026 findings (follow-up details and risk comparisons). Knowridge report
- Varbo, Balling et al., The Lancet Regional Health Europe (April 2025): remnant cholesterol as a causal risk factor for coronary heart disease. The Lancet Regional Health Europe paper
- University of Copenhagen research on remnant (“ugly”) cholesterol levels in the Copenhagen General Population Study. University of Copenhagen research
