Extra Belly Fat, Not Bmi, A Stronger Predictor Of Heart Failure Risk

• Researchers say extra abdominal fat is strongly associated with an increased risk of heart failure.
• Excess belly fat contributes to systemic inflammation, which endangers cardiovascular health.
• The researchers recommend that medical professionals measure waist circumference and inflammation to identify people at risk for heart-related conditions.

A new study reports that excess belly fat is more strongly associated with an increased risk of heart failure than a person’s overall body weight or their body mass index (BMI) measurement.

The researchers say that systemic inflammation is a key factor in the link between abdominal fat and heart disease risk. They estimate that one-quarter to one-third of the association is explained by inflammation.

These findings suggest that reducing inflammation is a potential treatment strategy to reduce the risk of heart failure in people with excess abdominal fat.

The research has not yet been published in a peer-reviewed journal, but is being presented March 17–20 at the AHA’s EPI/Lifestyle Scientific Sessions 2026 conference in Boston.

The researchers said they hope their analysis will encourage new approaches to heart health monitoring.

“This research helps us understand why some people develop heart failure despite having a body weight that seems healthy,” said Szu-Han Chen, the lead author of the study and a medical student at National Yang Ming Chiao Tung University in Taiwan, in a statement.

“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,” Chen continued.

Belly fat, inflammation, and heart health

This new research follows a scientific statement published by the American Heart Association (AHA) in May 2025.

In that statement, medical professionals explained that inflammation in the body can disrupt a person’s immune system, damage blood vessels, and lead to the buildup of scar tissue in the heart.

The Heart Association has also launched a Systematic Inflammation Data Challenge, encouraging collaboration on how inflammation contributes to heart disease and related conditions.

Experts not involved in the study told Healthline that this new research is important.

“This study reinforces an important concept in cardiology: where fat is stored in the body may matter more than total body weight alone,” said Kevin Shah, MD, a cardiologist and program director of Heart Failure Outreach at MemorialCare Heart & Vascular Institute at the Long Beach Medical Center in California.

“One practical takeaway from this study is that clinicians and patients may want to pay more attention to waist circumference and central obesity, since those measures may reveal cardiovascular risk even in individuals whose BMI appears normal,” Shah said.

Mir Ali, MD, a bariatric surgeon and medical director of the MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California, agreed.

“This is a strong study that aligns with existing research indicating that central or truncal obesity poses a greater risk for cardiovascular disease than peripheral obesity,” Ali said.

Inflammation linked to higher heart failure risk

For their study, the researchers analyzed data from nearly 2,000 African American adults enrolled in the Jackson Heart Study who lived in three counties, both urban and rural, near Jackson, MS.

The participants did not have a diagnosis of heart failure at the time they entered the study between 2000 and 2004.

Participants’ ages ranged from 35 to 84, with an average age of 58. About 36% were female. The subjects were studied for a median of nearly 7 years through December 2016.

Researchers assessed the participants’ body fat by using measures such as overall weight, BMI, waist circumference, and waist-to-height ratio. Blood samples were used to measure high-sensitivity C-reactive protein, a commonly used marker of inflammation.

The researchers reported that 112 participants developed heart failure during the follow-up period. They noted that elevated waist circumference was associated with increased heart failure risk, whereas high BMI was not.

They also found that higher waist circumference and waist-to-height ratio were associated with an increased risk of heart failure. They further reported that participants with higher inflammation levels were more likely to experience heart failure.

The researchers noted that they did not have access to participants’ heart failure subtypes, so their study reported on overall heart failure risk.

Experts said that, even though this study was limited to African American participants in one part of the country, the findings are pertinent to the nation’s population as a whole.

“I believe these results can be extrapolated to other populations as previous research has demonstrated similar findings across different groups,” Ali said.

“We should be cautious about over-generalizing the findings,” said Shah. “However, the biological mechanisms linking visceral fat, inflammation, and cardiovascular disease are well established across many populations, so the results are likely relevant more broadly, even if additional studies in diverse groups are needed.”

How belly fat affects heart health

Experts say that excess belly fat contributes to heart health risks in several ways.

“Visceral fat is metabolically active and releases inflammatory molecules that can contribute to insulin resistance, high blood pressure, and vascular dysfunction,” Shah said. “Over time, chronic inflammation can damage blood vessels and place stress on the heart muscle, eventually increasing the likelihood of developing heart failure.”

“Belly fat envelops and impairs the function of internal organs,” said Ali. “Furthermore, obesity increases the body’s inflammatory response, which is theorized to stiffen the heart muscle and impair its pumping mechanism.”

Shah and Ali agreed that tracking abdominal fat is important. However, they said BMI measurements shouldn’t be totally disregarded either.

“BMI remains a reasonable tool for assessing obesity levels and associated health risks,” said Ali. “While it is not perfect — as it does not account for body composition or fat distribution — it is simple to calculate and remains the standard used by practitioners and insurance companies to classify obesity.”

“BMI is still a useful screening tool because it is easy to measure and helps identify people at risk for obesity-related disease,” said Shah. “However, BMI does not capture fat distribution, which is why measures like waist circumference or waist-to-height ratio can sometimes provide additional insight into cardiovascular risk.”

How to reduce belly fat to improve heart health

It’s estimated that more than 900,000 people die from cardiovascular disease every year in the United States. That accounts for almost one-third of all deaths annually in the country.

Heart disease is listed as the number one cause of death for males, females, and people of most racial and ethnic groups.

A number of factors are considered to be contributors to increased disease risk. Among them:

• high blood pressure
• high cholesterol levels
• diabetes
• excessive alcohol use
• obesity

It’s estimated that 40% of U.S. adults have obesity. The percentages are similar for males and females. Among age groups, the obesity prevalence is highest for people ages 40 to 59.

Obesity is associated with an increased risk of a number of diseases and conditions, including cardiovascular disease and stroke.

Healthline’s 7-day heart health reset offers tips for adopting simple lifestyle behaviors that can support long-term heart health.

Experts say there are daily habits that can help people lose weight and reduce abdominal fat.

“General weight loss is the most effective way to reduce abdominal fat and the resulting inflammation,” said Ali. “It is important to note that you cannot ‘spot-reduce’ fat. While abdominal exercises strengthen muscles, the body burns fat from across the entire body. Significant changes to diet and lifestyle are necessary for meaningful weight loss,” he continued.

Shah recommended implementing several daily routines. These include:

• regular exercise
• a diet rich in whole foods, fiber, nuts, fruits, and vegetables
• avoiding sugar and ultra-processed foods
• quality sleep

“The most effective strategies focus on improving overall metabolic health,” he said.