Belly Fat, Not BMI, Key Heart Failure Predictor

Excess abdominal fat linked to higher heart failure risk due to inflammation

Mar. 18, 2026 at 7:09am

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New research suggests that measures of excess weight around the waist (central obesity or visceral fat) may increase the risk of heart failure primarily due to inflammation. The study found that higher levels of visceral fat were more strongly linked to heart failure risk than overall body weight, and higher waist measurements identified higher risk even when body mass index (BMI) appeared normal. The findings indicate that where fat is stored in the body may matter more than weight, and point to opportunities to identify people at higher risk of heart failure using waist measurements rather than relying only on BMI.

Why it matters

This research helps explain why some people develop heart failure despite having a body weight that seems healthy. By monitoring waist size and inflammation, clinicians may be able to identify people with higher risk earlier and focus on prevention strategies that could reduce the chance of heart failure before symptoms begin.

The details

The study analyzed health data for 1,998 African American adults in Jackson, Mississippi, enrolled in the Jackson Heart Study. Participants did not have heart failure at the start of the study. Researchers assessed body fat using measures including weight, BMI, waist circumference and waist-to-height ratio. Blood samples were tested to measure inflammation. The study found that elevated measurements of excess weight around the waist were associated with increased heart failure risk, while high BMI was not. Inflammation accounted for about one-quarter to one-third of the link between measures of fat stored around the waist and heart failure risk.

  • The study followed participants for a median of 6.9 years, through December 31, 2016.
  • Participants were ages 35-84 years old at enrollment, with an average age of 58 years.

The players

Szu-Han Chen

Lead author of the study and a medical student at National Yang Ming Chiao Tung University in Taiwan.

Sadiya S. Khan, M.D., M.Sc., FAHA

Volunteer chair of the American Heart Association's 2025 Scientific Statement: Risk-Based Primary Prevention of Heart Failure, and Magerstadt Professor of Cardiovascular Epidemiology and an associate professor of cardiology and preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago.

American Heart Association

The organization that presented the research at its EPI|Lifestyle Scientific Sessions 2026.

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What they’re saying

“This research helps us understand why some people develop heart failure despite having a body weight that seems healthy. By monitoring waist size and inflammation, clinicians may be able to identify people with higher risk earlier and focus on prevention strategies that could reduce the chance of heart failure before symptoms begin.”

— Szu-Han Chen, Lead author of the study (Mirage News)

“This study highlights the importance of integrating measures of central adiposity such as waist circumference into routine preventive care. Understanding upstream drivers of heart failure risk including central adiposity is key to recognizing and modifying risk.”

— Sadiya S. Khan, M.D., M.Sc., FAHA, Volunteer chair of the American Heart Association's 2025 Scientific Statement: Risk-Based Primary Prevention of Heart Failure (Mirage News)

What’s next

Future research should examine how visceral fat and inflammation relate to different types of heart failure and whether reducing inflammation can help prevent or reduce the risk of heart failure.

The takeaway

This study suggests that measuring waist size and inflammation levels may be more effective than relying solely on BMI to identify individuals at higher risk of developing heart failure. These findings highlight the importance of considering where fat is stored in the body, not just overall weight, when assessing heart health.