Waist Size and Inflammation More Predictive of Heart Failure Risk Than BMI, Study Finds

Research presented at the American Heart Association's EPI|Lifestyle Scientific Sessions 2026 suggests that measurements of excess weight around the waist may increase heart failure risk 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, with higher waist measurements identifying elevated risk even when body mass index appeared normal. According to the findings, inflammation may help explain why belly fat is particularly harmful to heart health, indicating that where fat is stored in the body may matter more than weight alone.

The study analyzed health data for 1,998 African American adults enrolled in the Jackson Heart Study who did not have heart failure at enrollment. During a median follow-up period of 6.9 years, 112 participants developed heart failure. Researchers found that elevated measurements of excess weight around the waist were associated with increased heart failure risk, while high BMI was not. Both higher waist circumference and waist-to-height ratio were each associated with increased heart failure risk. Participants with higher inflammation levels, as measured by blood tests for high-sensitivity C-reactive protein, were more likely to experience heart failure over the follow-up period. The analysis revealed that inflammation accounted for approximately one-quarter to one-third of the link between measures of fat stored around the waist and heart failure risk.

"This research helps us understand why some people develop heart failure despite having a body weight that seems healthy," said Szu-Han Chen, lead author of the study and a medical student at National Yang Ming Chiao Tung University in Taiwan. The mediating role of inflammation in the association between central obesity and heart failure suggests that reducing inflammation levels may be a potential treatment strategy to reduce heart failure risk in these individuals. According to a 2025 scientific statement from the American Heart Association focused on risk-based primary prevention of heart failure, systemic inflammation is a common risk factor for heart disease because it can disrupt the immune system, damage blood vessels and lead to scar tissue buildup in the heart. The Association has highlighted evidence that higher inflammation levels are linked to increased heart disease risk, even in adults with normal cholesterol levels.

"This study highlights the importance of integrating measures of central adiposity such as waist circumference into routine preventive care," said 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. The American Heart Association recently launched the Systemic Inflammation Data Challenge to encourage collaboration and deepen understanding of how inflammation contributes to heart disease and related conditions including heart failure. Researchers noted they did not have access to participants' heart failure subtypes, so findings apply to all types of heart failure together. Future research should examine how visceral fat and inflammation relate to different heart failure types and whether reducing inflammation can help prevent or reduce heart failure risk.