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, according to findings presented at the American Heart Association’s EPI|Lifestyle Scientific Sessions 2026. The meeting, held March 17-20 in Boston, offers the latest epidemiological science on prevention, lifestyle and cardiometabolic health.
In this study, researchers found that measurements of 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 study found that inflammation may help explain why belly fat is especially harmful to heart health, suggesting that where fat is stored in the body may matter more than weight. These findings point to opportunities to identify people at higher risk of heart failure using waist measurements rather than relying only on BMI.
“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. “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.”
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 the build up of scar tissue in the heart.
The study found that among 1,998 African American adults from the Jackson Heart Study, 112 developed heart failure during a median follow-up of 6.9 years. Elevated measures of excess weight around the waist were associated with increased heart failure risk, while high BMI was not. Higher waist circumference and waist-to-height ratio were each associated with increased risk. Participants with higher inflammation levels, as measured by high-sensitivity C-reactive protein, were more likely to experience heart failure. Inflammation accounted for about one-quarter to one-third of the link between abdominal fat and heart failure risk.
“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 Association’s 2025 scientific statement and Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University. “Future research should identify if central adiposity has greater predictive utility beyond strength of association.”
The researchers noted that they did not have access to participants’ heart failure subtypes, so the findings are about 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 risk.
