A new study led by researchers at Johns Hopkins Medicine provides compelling evidence that certain blood markers—indicating early, silent damage or stress in the heart—are linked to a higher risk of heart failure in adults who have both high blood pressure and prediabetes. These markers reflect subtle changes in the heart muscle that occur before any obvious symptoms, such as those seen during a heart attack, begin to appear.
The findings suggest that a group of people who may seem relatively healthy could, in fact, face a significantly elevated risk of developing heart failure. Importantly, these individuals can be identified through routine blood tests, offering a practical way for clinicians to intervene early and potentially prevent more serious outcomes. The study was funded by the National Institutes of Health and published in JAMA Cardiology, underscoring how common and often unnoticed health issues can combine to increase cardiovascular risk.
Prediabetes plays a central role in this research. It is a condition in which blood sugar levels are higher than normal but not yet high enough to be diagnosed as diabetes. Although it may not cause immediate symptoms, prediabetes is widespread and is already known to increase the risk of heart, kidney, and nerve problems. The study highlights that when prediabetes occurs alongside high blood pressure and early signs of heart stress, the combined effect can be particularly harmful.
To better understand this risk, the researchers analysed data from more than 8,000 adults aged 50 and older who took part in the SPRINT trial. This large clinical study originally examined how lowering blood pressure affects overall health. For this new analysis, participants did not have diagnosed diabetes, allowing researchers to focus specifically on the role of prediabetes and early heart changes.
At the start of the study, a substantial proportion of participants had prediabetes, while many also showed signs of silent heart injury or stress based on specific blood biomarkers. Over an average follow-up period of just over three years, the results were striking. Individuals who had both prediabetes and these early heart changes were about ten times more likely to develop heart failure compared to those without these combined risk factors. By contrast, people without prediabetes but with similar heart markers showed only a moderate increase in risk.
The researchers also looked at how changes in these biomarkers over time affected outcomes. They found that participants whose biomarker levels increased significantly within the first year were much more likely to develop heart failure later on, particularly if they also had prediabetes. Interestingly, prediabetes on its own was not linked to a higher or lower risk, suggesting that it is the combination with underlying heart stress that drives the danger.
Overall, the study highlights an important opportunity for early detection and prevention. By using simple blood tests, clinicians may be able to identify patients who are quietly at high risk and begin treatment before serious heart problems develop. As senior author Justin Basile Echouffo Tcheugui explains, recognising these vulnerable groups could help shift care towards prevention, ensuring that patients receive support before a medical emergency occurs.
More information: Arnaud D. Kaze et al, Prediabetes, Subclinical Myocardial Injury or Stress, and Heart Failure Risk for Adults With Hypertension, JAMA Cardiology. DOI: 10.1001/jamacardio.2025.4927
Journal information: JAMA Cardiology Provided by Johns Hopkins Medicine
