A new study finds that excess abdominal fat is more strongly linked to future heart failure than overall body weight or body mass index (BMI). Researchers say systemic inflammation helps explain much of that connection and suggest clinicians measure waist size and inflammation markers to identify people at higher risk earlier.
Study details and findings
Researchers analyzed data from nearly 2,000 African American adults enrolled in the Jackson Heart Study who lived in three counties near Jackson, Mississippi. Participants, aged 35 to 84 (mean age 58) and about 36% female, entered the study between 2000 and 2004 and were followed for a median of nearly seven years through December 2016. None had heart failure at baseline.
Body fat was assessed using weight, BMI, waist circumference, and waist-to-height ratio. Blood tests measured high-sensitivity C-reactive protein (hs-CRP) as a marker of systemic inflammation. During follow-up, 112 participants developed heart failure.
The investigators found that larger waist circumference and higher waist-to-height ratio were associated with increased heart failure risk, while elevated BMI was not. Higher inflammation levels were also linked to greater risk. The team estimated that roughly one-quarter to one-third of the association between abdominal fat and heart failure could be explained by inflammation.
Implications and expert perspectives
Lead author Szu-Han Chen said monitoring waist size and inflammation could help clinicians identify people at elevated risk even when BMI appears normal, allowing earlier prevention efforts.
The findings echo a May 2025 scientific statement from the American Heart Association (AHA) describing how systemic inflammation can damage blood vessels, disrupt immune responses, and promote scarring in the heart. The AHA has also launched a Systematic Inflammation Data Challenge to spur research into inflammation’s role in heart disease.
Cardiology experts not involved in the study said it reinforces the importance of fat distribution over total weight alone. Kevin Shah, MD, noted that measures of central obesity such as waist circumference can reveal cardiovascular risk that BMI may miss. Mir Ali, MD, said the results align with prior research showing truncal or visceral obesity carries greater cardiovascular risk than peripheral fat.
Biological mechanisms
Visceral fat is metabolically active and releases inflammatory molecules that contribute to insulin resistance, high blood pressure, and vascular dysfunction. Chronic inflammation can damage blood vessels and strain the heart muscle, potentially leading to stiffening and impaired pumping ability over time. Excess abdominal fat may also impair the function of internal organs and amplify the body’s inflammatory response.
Clinical caveats
The study’s participants were all African American adults from a single region, so generalizability should be considered cautiously. Experts note, however, that the biological links between visceral fat, inflammation, and heart disease have been observed across diverse populations, suggesting the findings are likely relevant more broadly while additional studies in other groups are warranted.
Public health context
Cardiovascular disease causes substantial mortality in the United States—an estimated more than 900,000 deaths per year, roughly one-third of all deaths. About 40% of U.S. adults have obesity, with the highest prevalence among those aged 40 to 59. Obesity is a major contributor to cardiovascular disease and stroke.
Prevention and management
Clinicians and patients can track abdominal fat with waist circumference and consider inflammation markers when assessing risk. While BMI remains a useful, simple screening tool for obesity and related health risks, it does not capture fat distribution; waist measures and waist-to-height ratio can add important insight.
Experts recommend lifestyle strategies to reduce abdominal fat and inflammation, including regular exercise, a diet focused on whole foods with fiber, nuts, fruits, and vegetables, avoiding excess sugar and ultra-processed foods, and getting quality sleep. General weight loss is the most effective way to reduce visceral fat; targeted “spot reduction” is not supported, so meaningful changes require overall diet and lifestyle modification.
Conclusion
This study suggests that where fat is stored—particularly around the abdomen—matters more for heart failure risk than BMI alone, with systemic inflammation playing a significant mediating role. Measuring waist circumference and inflammation could improve early identification of at-risk individuals and guide preventive strategies to reduce the chance of heart failure.
