{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T08:05:53Z","timestamp":1792483553698,"version":"4.5.0"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Obesity and systemic inflammation have each been independently associated with an increased risk of heart failure (HF). However, whether inflammatory pathways mediate the association between obesity and the development of heart failure remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We analyzed data from a community\u2010based cohort of 1998 participants to evaluate multiple adiposity indicators in relation to incident HF. hs\u2010CRP (high\u2010sensitivity C\u2010reactive protein) was examined as a mediator using causal mediation analysis to quantify the contribution of systemic inflammation. Kaplan\u2013Meier analyses and multivariable Weibull accelerated failure time models were applied to estimate hazard ratios (HRs) for HF occurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Over a median follow\u2010up of 6.9\u2009years, individuals with elevated hs\u2010CRP levels showed significantly lower HF\u2010free survival (log\u2010rank\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.010). In multivariable accelerated failure time models, indicators of central obesity and hs\u2010CRP\u2014but not BMI\u2014were significantly associated with higher HF risk (eg, waist circumference: HR=1.30 [95% CI: 1.05\u20131.61],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.017; hs\u2010CRP: HR=1.25 [1.05\u20131.51],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.013). Mediation analysis revealed that hs\u2010CRP accounted for 26.5% of the effect of waist circumference and 32.4% of the effect of waist\u2010to\u2010height ratio on HF risk, with statistically significant indirect effects for both.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Our findings build upon recent conceptual advances by demonstrating that central obesity contributes to HF largely through inflammation. By quantifying the proportion of HF risk attributable to systemic inflammation, this study reinforces the rationale for prioritizing both anti\u2010obesity and anti\u2010inflammatory strategies in HF prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.126.049997","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:15:21Z","timestamp":1785496521000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Central Adiposity, Systemic Inflammation, and Incident Heart Failure: A Causal Mediation Analysis From the Jackson Heart Study"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4557-9097","authenticated-orcid":false,"given":"Szu\u2010Han","family":"Chen","sequence":"first","affiliation":[{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4707-1867","authenticated-orcid":false,"given":"Yu\u2010Hsuan","family":"Lee","sequence":"additional","affiliation":[{"name":"Taipei Veterans General Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2138-4771","authenticated-orcid":false,"given":"Shao\u2010Yuan","family":"Chuang","sequence":"additional","affiliation":[{"name":"Institute of Population Health Science, National Health Research Institute","place":["Miaoli, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8671-7007","authenticated-orcid":false,"given":"Marat","family":"Fudim","sequence":"additional","affiliation":[{"name":"Duke University Medical Center","place":["Durham, USA"]},{"name":"Duke Clinical Research Institute","place":["Durham, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5984-4249","authenticated-orcid":false,"given":"Chun\u2010Wei","family":"Lee","sequence":"additional","affiliation":[{"name":"National Yang Ming Chiao Tung University College of Medicine","place":["Taipei, Taiwan"]},{"name":"MacKay Memorial Hospital, MacKay Medical College","place":["New Taipei City, Taiwan"]},{"name":"MacKay Junior College of Medicine, Nursing and Management","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5359-3677","authenticated-orcid":false,"given":"Chi\u2010Jung","family":"Huang","sequence":"additional","affiliation":[{"name":"Taipei Veterans General Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3885-6600","authenticated-orcid":false,"given":"Hao\u2010Min","family":"Cheng","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University","place":["Taipei, Taiwan"]},{"name":"Taipei Veterans General Hospital","place":["Taipei, Taiwan"]},{"name":"Taipei Veterans General Hospital","place":["Taipei, Taiwan"]},{"name":"Taipei Veterans General Hospital","place":["Taipei, Taiwan"]},{"name":"College of Medicine, National Yang Ming Chiao Tung University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvac013"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(18)32279-7"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/HHF.0b013e318291329a"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae403"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2015.10.002"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.trsl.2014.05.008"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000973"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa020245"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2022.155217"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00033.2011"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2010.5"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.06.027"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-024-02518-2"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(05)67663-5"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1017\/s0007114511005460"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2013.11.006"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9343(99)00066-2"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-39051-3"},{"key":"e_1_3_2_20_2","first-page":"92","article-title":"High sensitivity C\u2010reactive protein levels in acute ischemic stroke and subtypes: a study from a tertiary care center","volume":"12","author":"Chaudhuri JR","year":"2013","unstructured":"Chaudhuri JR, Mridula KR, Umamahesh M, Swathi A, Balaraju B, Bandaru VC. High sensitivity C\u2010reactive protein levels in acute ischemic stroke and subtypes: a study from a tertiary care center. Iran J Neurol. 2013;12:92\u201397.","journal-title":"Iran J Neurol"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.2174\/1381612826666200717090334"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2024.131818"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.296.3302"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvz198"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.025464"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.032997"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2025.07.052"},{"key":"e_1_3_2_28_2","article-title":"The Jackson heart study: an overview","volume":"15","author":"Taylor HA","year":"2005","unstructured":"Taylor HA Jr. The Jackson heart study: an overview. Ethn Dis. 2005;15:S6\u20101\u20103.","journal-title":"Ethn Dis"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-1378"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0255609"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.05.049"},{"key":"e_1_3_2_32_2","first-page":"S6","article-title":"Cardiovascular disease event classification in the Jackson heart study: methods and procedures","volume":"15","author":"Keku E","year":"2005","unstructured":"Keku E, Rosamond W, Taylor HA Jr, Garrison R, Wyatt SB, Richard M, Jenkins B, Reeves L, Sarpong D. Cardiovascular disease event classification in the Jackson heart study: methods and procedures. Ethn Dis. 2005;15:S6\u201362\u201370.","journal-title":"Ethn Dis"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.30225"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2016.00423"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2011.04023.x"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.1103011"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1177\/1741826710394305"},{"key":"e_1_3_2_38_2","first-page":"214","article-title":"Lean mass and fat mass as contributors to physical fitness in an overweight and obese African American population","volume":"25","author":"Yanek LR","year":"2015","unstructured":"Yanek LR, Vaidya D, Kral BG, Dobrosielski DA, Moy TF, Stewart KJ, Becker DM. Lean mass and fat mass as contributors to physical fitness in an overweight and obese African American population. Ethn Dis. 2015;25:214\u2013219.","journal-title":"Ethn Dis"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2563"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004138"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1080\/13813455.2020.1733617"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1172\/jci117899"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-1696"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1038\/emm.2003.56"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.redox.2015.06.018"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lfs.2022.120860"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf658"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.50.5908"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.01.014"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2306963"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.126.049997","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T03:41:33Z","timestamp":1789011693000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.126.049997"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":49,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2026,8,4]]}},"alternative-id":["10.1161\/JAHA.126.049997"],"URL":"https:\/\/doi.org\/10.1161\/jaha.126.049997","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]},"assertion":[{"value":"2026-02-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e049997"}}