Waist Circumference: A Better Predictor of Heart Failure Risk Than BMI?

For years, body mass index (BMI) has been a standard measure used to assess health risks. However, emerging research suggests that where you carry your weight—specifically, around your waist—may be a more accurate predictor of heart failure risk than BMI alone. A growing body of evidence indicates that excess abdominal fat, or visceral fat, is strongly linked to an increased risk of heart failure, even in individuals with a normal BMI. This connection appears to be significantly influenced by systemic inflammation.

The Link Between Belly Fat, Heart Failure, and Inflammation

A recent study presented at the American Heart Association’s EPI|Lifestyle Scientific Sessions 2026, analyzed data from nearly 2,000 adults participating in the Jackson Heart Study who did not have heart failure at the study’s outset. Researchers examined various indicators of body fat, including weight, BMI, waist-to-height ratio, and waist circumference, alongside levels of high-sensitivity C-reactive protein (hs-CRP) as a marker for inflammation.

The findings revealed that while BMI did not predict heart failure risk, both waist circumference and waist-to-height ratio were significant predictors. Elevated hs-CRP levels were associated with a lower heart failure-free survival rate. Importantly, inflammation accounted for approximately 25.4% of the effect of waist circumference, and 28.5% of the effect of waist-to-height ratio on heart failure risk.

Why Waist Circumference Matters More

Visceral fat, the type of fat stored around the abdominal organs, is metabolically active and releases inflammatory substances. This chronic inflammation can damage the heart and blood vessels, increasing the risk of heart failure. Unlike subcutaneous fat (the fat just under the skin), visceral fat is more closely linked to metabolic dysfunction and cardiovascular disease.

Szu-Han Chen, from the School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, explained that measures of central obesity, such as waist circumference and waist-to-height ratio, were associated with a higher risk of developing heart failure over time, whereas BMI itself was not significantly associated with heart failure risk in the analysis.

Limitations and Future Research

While these findings are promising, it’s important to acknowledge certain limitations. The Jackson Heart Study population is exclusively African American, which may limit the generalizability of the results to other ethnic groups. Further research is needed to determine if these findings hold true across diverse populations.

some experts note that while the study demonstrates a statistical link between inflammation and heart failure, it doesn’t definitively prove that inflammation *causes* heart failure. More research is needed to fully understand the biological mechanisms at play.

What Can You Do?

The good news is that reducing abdominal fat and inflammation is achievable through lifestyle modifications. Strategies include:

• Regular Physical Activity: A combination of aerobic exercise and resistance training can help reduce visceral fat and improve metabolic health.
• Healthy Diet: Focus on a diet rich in whole foods, fiber, fruits, vegetables, and healthy fats. Limit processed foods, sugary drinks, and excessive sugar intake.
• Improved Sleep Quality: Adequate sleep is crucial for hormonal balance and metabolic function.

Beyond BMI: A More Holistic Approach

These findings suggest that healthcare providers should consider waist circumference and waist-to-height ratio as part of a comprehensive cardiovascular risk assessment, even in individuals with a normal BMI. Paying attention to where fat is stored in the body may be just as important as how much a person weighs when it comes to preventing heart failure.