van Essen, Bart J, Dan, Nathalie Ang En, Tharsana, Ganash N et al. · International journal of cardiology · 2026 · DOI
This study found that people with a combination of obesity and physical inactivity have the highest risk of developing heart failure compared to other groups with different health problems. Researchers followed nearly 7,000 people for about 10 years and identified six distinct groups based on their health conditions, discovering that the obesity and inactivity group had almost 4 times higher risk of heart failure than the healthiest group.
ME/CFS patients often experience cardiovascular complications and comorbid conditions including post-exertional malaise limiting physical activity. This study's systematic approach to understanding how comorbidity clusters influence heart failure risk could inform better cardiovascular monitoring and management strategies for ME/CFS populations who frequently present with multiple overlapping health conditions.
This observational study cannot establish causation—it only demonstrates association between comorbidity clusters and heart failure risk. The study does not prove that obesity or inactivity directly causes heart failure, nor does it address whether the relationship differs in ME/CFS patients specifically or whether disease-specific factors (like post-exertional malaise) modify these associations.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
van Essen, Bart J, Dan, Nathalie Ang En, Tharsana, Ganash N, Kaur, Palvinder, Emmens, J E, Ouwerkerk, Wouter, et al. (2026). Obesity and inactivity cluster the strongest risk factor for the development of heart failure in a population-based study.. International journal of cardiology. https://doi.org/10.1016/j.ijcard.2025.133914
BibTeX
@article{mecfsatlas-van-essen-2026-obesity-inactivity,
author = {van Essen, Bart J and Dan, Nathalie Ang En and Tharsana, Ganash N and Kaur, Palvinder and Emmens, J E and Ouwerkerk, Wouter and Gansevoort, Ron T and Bakker, Stephan J L and de Boer, Rudolf A and Damman, Kevin and van Veldhuisen, Dirk J and Voors, Adriaan A and Tromp, Jasper},
title = {Obesity and inactivity cluster the strongest risk factor for the development of heart failure in a population-based study.},
journal = {International journal of cardiology},
year = {2026},
doi = {10.1016/j.ijcard.2025.133914},
note = {PubMed: 40976358},
url = {https://www.mecfsatlas.com/evidence/van-essen-2026-obesity-inactivity},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/van-essen-2026-obesity-inactivity
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