Slim but Belly Bulges? Abdominal Obesity Poses Greater Heart Failure Risk Than General Obesity

A new study has found that people who appear slim but carry excess fat around the abdomen may face greater health risks than those with general obesity.

Researchers from National Yang Ming Chiao Tung University in Taiwan presented findings on the link between abdominal obesity and heart failure at the American Heart Association (AHA) EPI Lifestyle Scientific Sessions 2026 held in Boston. The team tracked 1,998 African American adults living in Mississippi for an average of 6.9 years, during which 112 participants were diagnosed with heart failure.

The analysis showed that body mass index (BMI), the standard measure of obesity, did not show a clear correlation with heart failure incidence. In contrast, larger waist circumference and a higher waist-to-height ratio were significantly associated with increased heart failure risk. Even individuals whose weight fell within the normal range faced substantially elevated risk when fat was concentrated in the abdominal area, the researchers said.

The researchers attributed the difference to inflammation. Blood tests measuring inflammation levels revealed that approximately 25% to 33% of the association between abdominal fat and heart failure was explained by systemic inflammation. Inflammatory substances produced by visceral fat disrupt blood vessels and the immune system, accumulate damage to heart muscle, and ultimately lead to heart failure.

"These results explain why heart failure can develop even in people who appear outwardly healthy," said Su-Han Chen, the lead researcher. "By monitoring waist circumference and inflammation levels together, we can identify high-risk individuals before symptoms appear."

Sadiya Khan, a professor at Northwestern University and an AHA member, also emphasized the importance of the findings. "It is critical to incorporate abdominal obesity indicators into routine preventive care," Khan said. "This will play a key role in recognizing and managing heart failure risk at an early stage."

The AHA had previously identified systemic inflammation as a major risk factor for cardiovascular disease in an earlier report. Inflammation causes blood vessel damage and immune dysfunction, and promotes fibrosis of heart tissue, leading to reduced cardiac function, the report noted. Heart disease risk is known to increase even when cholesterol levels are normal if inflammation levels are elevated.

However, the study has limitations in that it did not distinguish between subtypes of heart failure. The researchers said further studies are needed to examine how abdominal fat and inflammation affect specific heart failure subtypes and whether anti-inflammatory treatments can translate into actual preventive benefits.