Belly fat bombshell: Why your waistline matters more than BMI for heart failure risk

The meeting is in Boston, March 17-20, and offers the latest epidemiological science on prevention, lifestyle and cardiometabolic health.

In this study, researchers found that measurements of higher levels of visceral fat were more strongly linked to heart failure risk than overall body weight, and higher waist measurements identified higher risk even when body mass index (BMI) appeared normal.

The study found that inflammation may help explain why belly fat is especially harmful to heart health, suggesting that where fat is stored in the body may matter more than weight. These findings point to opportunities to identify people at higher risk of heart failure using waist measurements rather than relying only on BMI.

“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.”

According to a 2025 scientific statement from the American Heart Association focused on risk-based primary prevention of heart failure, systemic inflammation, or inflammation found throughout the body, is a common risk factor for heart disease because it can disrupt the immune system, damage blood vessels and lead to the build up of scar tissue in the heart.

The Association has also highlighted evidence that higher levels of inflammation in the body are linked to an increased risk of heart disease, even in adults with normal cholesterol levels.

The study found:

112 adults developed heart failure during the median follow-up period of 6.9 years;

elevated measurements of excess weight around the waist were associated with increased heart failure risk, while high BMI was not;

higher waist circumference and waist-to-height ratio were each associated with increased heart failure risk;
over the follow-up period of almost 7 years, participants with higher inflammation levels, as measured by blood tests, were more likely to experience heart failure; and

inflammation accounted for about one-quarter to one-third of the link between measures of fat stored around the waist and heart failure risk.

“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.

The researchers noted that they did not have access to participants’ heart failure subtypes, therefore, the findings are about all types of heart failure together. Future research should examine how visceral fat and inflammation relate to different types of heart failure and whether reducing inflammation can help prevent or reduce the risk of heart failure.

Study details, background and design:  

Analysis included health data for 1,998 African American adults in three counties in urban and rural Jackson, Mississippi, enrolled in the Jackson Heart Study. Participants did not have heart failure at the time of enrollment in the Jackson Heart Study, 2000-2004.

Participants were ages 35-84 years old at enrollment, with an average age of 58 years; 36% were women, and they were followed for a median of 6.9 years, through December 31, 2016.

Researchers assessed participants’ body fat using measures including weight, body mass index (BMI), waist circumference and waist-to-height ratio.

Blood samples were tested to measure high-sensitivity C-reactive protein, a commonly used marker of inflammation in the body.

This study was conducted under the guidance of Professor Hao-Min Cheng at Taipei Veterans General Hospital and National Yang Ming Chiao Tung University.

The American Heart Association recently launched the Systemic Inflammation Data Challenge to encourage collaboration and deepen understanding of how inflammation contributes to heart disease and related conditions including heart failure.

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