A new study presented at the American Heart Association’s EPI|Lifestyle Science Session 2026 suggests that fat stored around the waist (central obesity or visceral fat) may increase the risk of heart failure primarily due to inflammation. The conference, held March 17-20 in Boston, will highlight the latest discoveries in prevention, lifestyle, and cardiometabolic health.
The study found that higher levels of visceral fat were more closely associated with heart failure risk than overall body weight. Even in people whose body mass index (BMI) was within the normal range, a larger waist measurement was associated with increased risk. These results suggest that where fat is stored in the body may be more important than a person’s weight. Inflammation seems to explain why belly fat has such a big impact on heart health. Therefore, measuring waist size may be a better way to identify people at higher risk than relying on BMI alone.
“This study helps us understand why some people develop heart failure despite a seemingly healthy weight,” said study lead author Szu-Han Chen, a medical student at National Yangming Jiaotong University in Taiwan. “By monitoring waist size and inflammation, clinicians may be able to identify high-risk individuals early and focus on preventive strategies that reduce the likelihood of heart failure before symptoms appear.”
The role of inflammation in heart disease
The American Heart Association’s 2025 Scientific Statement on Risk-Based Primary Prevention of Heart Failure highlights systemic inflammation, or inflammation throughout the body, as the primary cause of heart disease. It can disrupt immune function, damage blood vessels, and promote the buildup of scar tissue within the heart. The association also reports that high levels of inflammation increase the risk of heart disease, even in people with normal cholesterol levels.
Key findings from the research
The researchers reported several important observations.
- 112 participants developed heart failure with a median follow-up of 6.9 years
- Higher levels of excess fat around the waist were associated with increased heart failure risk, but higher BMI did not increase heart failure risk.
- Both waist circumference and waist-to-height ratio were associated with increased risk.
- Participants with higher levels of inflammation measured by blood tests were more likely to develop heart failure over nearly seven years
- Inflammation accounts for about a quarter to a third of the relationship between abdominal fat and heart failure risk
Implications for prevention and screening
“This study highlights the importance of incorporating measurements of central fat, such as waist circumference, into routine preventive care. Understanding upstream factors of heart failure risk, including central fat, is key to recognizing and modifying risk,” said Sadiya S. Khan, MD, MS, FAHA, volunteer chair of the American Heart Association’s 2025 Scientific Statement: Risk-Based Primary Prevention of Heart Failure. “This study builds on previous research that highlighted the importance of excess or dysfunctional fat depots in the development of heart failure, and this study suggested incorporating BMI into the PREVENT-HF risk equation for estimating heart failure risk. However, future studies should consider whether central fat depots are relevant We need to find out whether it has greater predictive utility beyond its strength.” Kahn, who was not involved in the study, is a professor of cardiovascular epidemiology at Magerstadt and an associate professor of cardiology and preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.
Research limitations and next steps
The researchers noted that this finding applies to heart failure overall, as detailed data on different types of heart failure are not available. Future research is needed to investigate how visceral fat and inflammation influence specific subtypes of heart failure and whether reducing inflammation can help lower risk.
Study design and participant details
The analysis included health data for 1,998 African American adults living in both urban and rural areas of Jackson, Mississippi, who participated in the Jackson Heart Study. None of the participants had heart failure at the time of enrollment from 2000 to 2004.
Participants ranged in age from 35 to 84 years, with a mean age of 58 years, and 36% were female. Patients were followed for a median of 6.9 years until December 31, 2016.
Researchers assessed body fat using several measures, including weight, body mass index (BMI), waist circumference, and waist-to-height ratio. Blood samples were also analyzed for high-sensitivity C-reactive protein, which is widely used as a marker of inflammation.
The study was conducted under the direction of Professor Haomin Chen from Taipei Veterans General Hospital and National Yangming Jiaotong University.
