Belly fat raises heart failure risk even in people with a normal body weight, and inflammation appears to be the primary mechanism linking the two, according to new research presented at the American Heart Association‘s EPI|Lifestyle Scientific Sessions 2026.
The study tracked participants over a median follow-up of 6.9 years, during which 112 developed heart failure. Higher levels of abdominal fat correlated with increased risk throughout that period. Higher BMI did not.
Both waist circumference and waist-to-height ratio were independently tied to greater heart failure risk, suggesting that the location of fat in the body carries more predictive weight than total body mass. Inflammation — measured through blood tests — accounted for roughly one-quarter to one-third of the statistical connection between abdominal fat and heart failure development.
Systemic inflammation can impair immune function, damage blood vessels, and drive the buildup of scar tissue in the heart. The American Heart Association has previously reported that elevated inflammation levels increase heart disease risk even in people with normal cholesterol, and its 2025 scientific statement on primary prevention of heart failure identified systemic inflammation as a major contributor to the disease.
Why BMI Alone May Miss the Risk
“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 and a medical student at National Yang Ming Chiao Tung University in Taiwan. Monitoring waist size alongside inflammation markers, Chen said, could allow clinicians to identify at-risk patients before symptoms appear.
The findings have direct implications for how routine screenings are structured. Waist measurement is simple, low-cost, and widely available — yet it is not standard in most preventive care protocols, which continue to rely heavily on BMI.
What Experts Say About Next Steps
Sadiya S. Khan, M.D., M.Sc., FAHA, who chairs the American Heart Association‘s 2025 Scientific Statement on Risk-Based Primary Prevention of Heart Failure and was not involved in this study, called for integrating central adiposity measures into routine care. “Understanding upstream drivers of heart failure risk including central adiposity is key to recognizing and modifying risk,” she said. Khan also noted that while this study demonstrates a strong association, future research should determine whether central adiposity offers predictive value beyond that association — including whether it improves on the PREVENT-HF risk equations, which currently incorporate BMI.
The research was presented in Boston, where the conference ran from March 17 to 20.
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