Belly fat linked to heart failure risk even in people with normal weight

The study found that higher levels of visceral fat were more closely tied to heart failure risk than overall body weight. Larger waist measurements were linked to increased risk even in people whose body mass index (BMI) fell within a normal range. These results suggest that where fat is stored in the body may be more important than how much a person weighs. Inflammation appears to help explain why belly fat has such a strong impact on heart health. Measuring waist size may therefore provide a better way to identify people at higher risk 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.”

The Role of Inflammation in Heart Disease

A 2025 scientific statement from the American Heart Association on risk-based primary prevention of heart failure highlights systemic inflammation, or inflammation throughout the body, as a major contributor to heart disease. It can disrupt immune function, damage blood vessels, and promote the buildup of scar tissue in the heart. The Association has also reported that higher inflammation levels are linked to increased heart disease risk, even in people with normal cholesterol levels.

Key Findings From the Study

The researchers reported several important observations:

• 112 participants developed heart failure over a median follow-up period 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, measured through blood tests, were more likely to develop heart failure over nearly seven years
• Inflammation accounted for about one-quarter to one-third of the connection between abdominal fat and heart failure risk

Implications for Prevention and Screening

“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 Next Steps

The researchers noted that they did not have detailed data on different types of heart failure, so the findings apply to heart failure overall. Future studies are needed to explore how visceral fat and inflammation affect specific subtypes of heart failure and whether reducing inflammation could help lower risk.

Study Design and Participant Details

The analysis included health data from 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 when they enrolled 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 for 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.