You Can Have a Normal Weight and Still Be at Risk for Heart Failure
Research Highlights
- Fat stored around the waist, often called belly fat or visceral fat, showed a much stronger link to heart failure risk than body mass index (BMI), making waist size a more revealing measure of risk.
- Inflammation throughout the body emerged as a major factor connecting abdominal fat to heart failure, accounting for roughly one-quarter to one-third of that increased risk.
- Because inflammation plays such a central role, targeting and reducing inflammation could become an important strategy for lowering heart failure risk in people with excess belly fat.
Belly Fat and Heart Failure Risk
New findings presented at the American Heart Association’s EPI|Lifestyle Scientific Sessions 2026 suggest that excess fat around the waist (central obesity or visceral fat) may raise the risk of heart failure, largely due to inflammation. The conference, held in Boston from March 17 to 20, highlights the latest research on prevention, lifestyle, and cardiometabolic health.
Waist Size vs BMI in Predicting Risk
Researchers reported that higher levels of visceral fat were more closely associated with heart failure risk than overall body weight. Larger waist measurements were linked to increased risk even among individuals whose body mass index (BMI) fell within a normal range. The results indicate that fat distribution may play a more important role than total weight. Inflammation appears to be a key factor that helps explain why fat stored around the abdomen is particularly harmful to the heart. These findings suggest that measuring waist size could improve how clinicians identify people at higher risk, rather than relying on BMI alone.
“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.”
Inflammation as a Key Driver
A 2025 scientific statement from the American Heart Association on risk-based primary prevention of heart failure emphasizes that systemic inflammation, or inflammation throughout the body, is a major contributor to heart disease. It can interfere with the immune system, damage blood vessels, and promote the formation of scar tissue in the heart. The Association has also pointed to evidence that higher inflammation levels are linked to greater heart disease risk, even in people with normal cholesterol.
Key Study Findings
The study reported several important results:
- 112 adults developed heart failure over a median follow-up of 6.9 years
- Higher levels of excess fat around the waist were associated with increased heart failure risk, while higher BMI was not
- Both waist circumference and waist-to-height ratio were linked to greater risk
- Participants with higher inflammation levels, based on blood tests, were more likely to develop heart failure during the nearly seven-year follow-up
- Inflammation explained about one-quarter to one-third of the relationship between abdominal fat and heart failure risk
Implications for Prevention and Care
“This study highlights the importance of integrating measures of central adiposity such as waist circumference into routine preventive care. Understanding upstream drivers of heart failure risk including central adiposity is key to recognizing and modifying risk,“ said Sadiya S. Khan, M.D., M.Sc., FAHA, volunteer chair of the American Heart Association’s 2025 Scientific Statement: Risk-Based Primary Prevention of Heart Failure.
“This study builds on prior research that highlights the importance of excess or dysfunctional adiposity in the development of heart failure, which informed the inclusion of body mass index into the PREVENT-HF risk equations to estimate risk of heart failure. However, future research should identify if central adiposity has greater predictive utility beyond strength of association.”
Khan, who was not involved in the study, is also Magerstadt Professor of Cardiovascular Epidemiology and an associate professor of cardiology and preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago.
Study Limitations and Future Research
The researchers noted that they were unable to analyze specific types of heart failure, so the findings apply to heart failure overall. Future studies are needed to explore how visceral fat and inflammation may affect different forms of heart failure and whether reducing inflammation could lower risk.
Study Details and Design
The analysis included data from 1,998 African American adults living in urban and rural areas of Jackson, Mississippi, who participated in the Jackson Heart Study. None had heart failure at enrollment between 2000 and 2004.
Participants ranged in age from 35 to 84, with an average age of 58, and 36 percent were women. They were followed for a median of 6.9 years, through December 31, 2016.
Researchers evaluated body fat using several measures, including weight, body mass index (BMI), waist circumference, and waist-to-height ratio. Blood samples were also analyzed to measure high-sensitivity C-reactive protein, a widely used marker of inflammation.
The study was conducted under the guidance of Professor Hao-Min Cheng at Taipei Veterans General Hospital and National Yang Ming Chiao Tung University.