New research suggests that measures of excess weight around the waist may increase the risk of heart failure primarily due to inflammation, according to findings presented at the American Heart Association’s EPI|Lifestyle Scientific Sessions 2026. The study, involving nearly 2,000 African American adults from the Jackson Heart Study, found that higher waist circumference and waist-to-height ratio were each associated with increased heart failure risk, while body mass index alone was not a significant predictor.
Over a median follow-up of 6.9 years, 112 participants developed heart failure. Researchers measured systemic inflammation using high-sensitivity C-reactive protein levels and found that inflammation accounted for about one-quarter to one-third of the link between abdominal fat and heart failure risk. This suggests that where fat is stored in the body may matter more than overall weight, and that reducing inflammation could be a potential treatment strategy.
“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. “By monitoring waist size and inflammation, clinicians may be able to identify people with higher risk earlier and focus on prevention strategies.”
The findings align with a 2025 scientific statement from the American Heart Association on risk-based primary prevention of heart failure, which highlights systemic inflammation as a common risk factor. The study adds evidence that central adiposity may have greater predictive utility than BMI, though future research should examine how visceral fat and inflammation relate to different heart failure subtypes.
“This study highlights the importance of integrating measures of central adiposity such as waist circumference into routine preventive care,” said Sadiya S. Khan, M.D., M.Sc., FAHA, volunteer chair of the scientific statement and associate professor at Northwestern University. “Understanding upstream drivers of heart failure risk including central adiposity is key to recognizing and modifying risk.”
The researchers note that the findings are preliminary as the abstract has not been peer-reviewed. However, the study provides a compelling case for using waist measurements to identify individuals at higher risk of heart failure, regardless of BMI. The American Heart Association recently launched the Systemic Inflammation Data Challenge to further explore inflammation’s role in heart disease.
