Prediabetes is a common metabolic state between normal glucose regulation and diabetes, but its role in heart failure risk—especially among patients with hypertension—has been less well defined. To clarify this association, Arnaud D. Kaze from the Division of Cardiology, Banner–University Medical Center Phoenix, University of Arizona College of Medicine, and colleagues conducted a study published in
JAMA Cardiology.The researchers performed a post hoc prospective cohort analysis using data from the Systolic Blood Pressure Intervention Trial (SPRINT). The study included adults with hypertension without diabetes or prior heart failure at baseline. Prediabetes was defined by fasting plasma glucose levels of 100 to 125 mg/dL, while subclinical myocardial injury and stress were assessed using high-sensitivity cardiac troponin I and N-terminal pro–B-type natriuretic peptide.
Of the 8,234 participants analyzed (mean age 68 years; 37% women), about 40% had prediabetes. Subclinical myocardial injury and stress were observed in 36% and 44% of participants, respectively. During a median follow-up of 3.2 years, 122 individuals developed incident heart failure.
Key Findings:
- Participants with both prediabetes and elevated high-sensitivity cardiac troponin I had a substantially higher risk of developing heart failure compared with individuals who had normal glucose levels and no evidence of myocardial injury.
- A similar increase in heart failure risk was observed among those with prediabetes and elevated N-terminal pro–B-type natriuretic peptide, indicating the impact of underlying myocardial stress.
- The highest risk of incident heart failure was seen in individuals with prediabetes combined with either subclinical myocardial injury or stress, suggesting a synergistic effect of metabolic dysregulation and early cardiac abnormalities.
- Over 12 months, participants with prediabetes who showed a significant rise (≥25%) in hs-cTnI levels had the greatest subsequent risk of heart failure during follow-up.
- A comparable increase in heart failure risk was noted in those with prediabetes and a ≥25% rise in NT-proBNP levels over time.
- These findings highlight that monitoring longitudinal changes in cardiac biomarkers provides stronger prognostic information than relying on a single baseline measurement.
Overall, the results suggest that prediabetes, when combined with evidence of subclinical myocardial injury or stress, identifies a subgroup of hypertensive patients at substantially elevated risk for heart failure.
The authors emphasize that integrating glycemic status with cardiac biomarker profiling could enhance early risk identification and guide targeted preventive strategies. Such an approach may help clinicians intervene earlier in high-risk individuals, potentially reducing the long-term burden of heart failure in patients with hypertension.
Reference:
Kaze AD, Juraschek SP, Cohen JB, et al. Prediabetes, Subclinical Myocardial Injury or Stress, and Heart Failure Risk for Adults With Hypertension. JAMA Cardiol. Published online January 14, 2026. doi:10.1001/jamacardio.2025.4927
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