A recent analysis found that excess belly fat predicts future heart failure better than overall body weight or BMI, and that systemic inflammation helps explain much of the association. The investigators recommend adding waist measurements and inflammation testing to routine risk assessment to find people at higher risk sooner.
Study design and key results
Researchers examined data from nearly 2,000 African American adults enrolled in the Jackson Heart Study who lived in three counties near Jackson, Mississippi. Participants were 35 to 84 years old (mean age 58), about 36% were female, and they joined the study between 2000 and 2004. None had heart failure at baseline; they were followed for a median of almost seven years through December 2016. During follow-up, 112 participants developed heart failure.
Body composition was evaluated using weight, BMI, waist circumference, and waist-to-height ratio. Blood samples measured high-sensitivity C-reactive protein (hs-CRP) as a marker of systemic inflammation. Larger waist circumference and higher waist-to-height ratio were linked with greater heart failure risk, while higher BMI was not. Elevated hs-CRP was also associated with increased risk. The authors estimated that about one-quarter to one-third of the link between abdominal fat and heart failure could be accounted for by inflammation.
Clinical and expert perspectives
The study’s lead author, Szu-Han Chen, recommended that clinicians consider measuring waist size and inflammatory markers so they can detect elevated risk even when BMI is within a normal range and intervene earlier. The findings are consistent with a May 2025 scientific statement from the American Heart Association describing how systemic inflammation can injure blood vessels, alter immune responses, and promote scarring in the heart. The AHA has also launched a Systematic Inflammation Data Challenge to encourage research on inflammation’s role in cardiovascular disease.
Independent cardiologists said the results emphasize fat distribution rather than total body weight. Kevin Shah, MD, noted that central-obesity measures such as waist circumference can reveal cardiovascular risk that BMI may miss. Mir Ali, MD, observed that these results align with prior studies showing that central (visceral or truncal) fat carries higher cardiovascular risk than peripheral fat.
Biological mechanisms
Visceral fat is metabolically active and releases pro-inflammatory molecules that contribute to insulin resistance, higher blood pressure, and vascular dysfunction. Persistent inflammation can damage blood vessels and increase cardiac strain, potentially causing the heart to stiffen and lose pumping efficiency over time. Excess abdominal fat may also impair nearby organ function and amplify systemic inflammatory responses.
Limitations
All participants were African American adults from a single geographic area, which may limit how directly the results apply to other populations. However, many of the biological pathways linking visceral fat, inflammation, and heart disease have been observed in diverse groups, suggesting broader relevance while underscoring the need for additional studies in other populations.
Public health context
Cardiovascular disease remains a leading cause of death in the United States—responsible for roughly 900,000 or more deaths annually, about one-third of all deaths. Around 40% of U.S. adults have obesity, with the highest prevalence in people aged 40–59. Obesity is a major contributor to heart disease and stroke.
Prevention and management implications
Clinicians and patients can monitor abdominal fat using waist circumference and waist-to-height ratio, and consider inflammation markers such as hs-CRP when assessing risk. BMI remains a useful, simple screening tool for obesity and related risks, but it does not capture where fat is stored; waist-based measures add important information.
Lifestyle strategies to reduce visceral fat and inflammation include regular physical activity, a whole-foods diet rich in fiber, fruits, vegetables, nuts, and lean proteins, limiting added sugars and ultra-processed foods, and ensuring adequate sleep. Overall weight loss is the most effective way to lower visceral fat—targeted “spot reduction” is not supported—so sustained diet and lifestyle changes are needed.
Bottom line
This study indicates that abdominal fat distribution, more than BMI alone, better predicts future heart failure risk, and that systemic inflammation is a meaningful mediator of that relationship. Measuring waist circumference and inflammation markers could improve early identification of people at higher risk and help guide preventive measures to reduce the likelihood of heart failure.
