New research presented at the American Heart Association (AHA) EPI|Lifestyle Scientific Sessions 2026 highlighted that excess fat stored around the waist, known as central obesity or visceral fat. It is a more powerful predictor of heart failure risk than overall bodyweight as measured by body mass index (BMI). The findings suggest that fat distribution in the body matters more than total body weight. Individuals with higher wrist circumference or waist-to-height ratios were found to have a significantly increased risk of developing heart failure, even when their BMI falls within the normal range. This challenges the traditional reliance on BMI as the primary measure of obesity-related health risk and suggests that clinicians must incorporate waist measurements into routine assessments to better detect at-risk individuals.
The study detected systemic inflammation as a key factor linking abdominal fat to heart failure. Inflammation measured using biomarkers like high-sensitivity C-reactive protein (hs-CRP) accounted for about one-quarter to one-third of the association between visceral fat and heart failure risk. This indicates that excess belly fat can contribute to heart failure largely by promoting chronic inflammation throughout the body, which can damage blood vessels, disrupt immune responses, and lead to structural changes in the heart, like fibrosis or scarring. Over a median follow-up period of 6.9 years, 12 out of 1,998 participants developed heart failure, and those with higher levels of inflammation were more likely to experience this outcome. Notably, increased BMI was not linked to a higher risk of heart failure in this study, further reinforcing the limitations of BMI as a standalone metric.
The research collected data from the Jackson Heart Study, which included African American adults aged 35 to 84 years from communities in Jackson, Mississippi, who were initially free of heart failure. Participants were followed for nearly 7 years, and multiple measures of body composition were analyzed alongside inflammatory biomarkers to explore their relationship with cardiovascular outcomes. As per the lead researcher, Szu-Han Chen, these findings help explain why some individuals develop heart failure despite having a seemingly healthy body weight, underscoring the importance of monitoring central obesity and inflammatory markers in clinical practice. This study aligns with prior guidance from the AHA, which has identified systemic inflammation as a major contributor to cardiovascular disease and a potential target for prevention strategies.
Inflammation plays a central role in the development of heart disease by contributing to endothelial dysfunction, plaque formation, and myocardial damage, even in individuals without traditional risk factors such as high cholesterol. The results support the idea that reducing inflammation by lifestyle changes, medications, or other interventions could help lower the risk of heart failure in individuals with central obesity. Sadiya S. Khan noted that incorporating measures of central adiposity into risk prediction models may improve early detection and prevention efforts. However, further research is needed to determine whether these measures provide additional predictive value beyond existing tools. The study has limitations, including a lack of data on specific subtypes of heart failure, meaning the findings apply broadly rather than to specific forms of the condition.
Future research should explore how visceral fat and inflammation influence different types of heart failure and whether targeted interventions to reduce inflammation can effectively prevent or delay disease onset. Overall, this study provides important insights into the complex relationship between body fat distribution, inflammation, and cardiovascular risk. It highlights the potential for more personalized and precise approaches to assess and manage heart failure risk beyond traditional measures like BMI.
Reference: American Heart Association. Extra belly weight, not BMI, was a stronger predictor of heart failure risk, inflammation. Published March 17, 2026. Accessed March 19, 2026. Extra belly weight, not BMI, was a stronger predictor of heart failure risk, inflammation
