Key result
Compared with normoglycemic adults without malignant left ventricular hypertrophy, those with both prediabetes and malignant LVH had a significantly higher risk of incident heart failure (HR 3.55).
Why the study?
Prediabetes is common in hypertensive adults, but its contribution to heart failure risk, especially with subclinical myocardial abnormalities, remains uncertain.
Does the coexistence of prediabetes and malignant left ventricular hypertrophy increase the risk of incident heart failure in hypertensive adults without diabetes?
Cohort (n=8,131)
Yes
Does the coexistence of prediabetes and malignant left ventricular hypertrophy increase the risk of incident heart failure in hypertensive adults without diabetes?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Although the biomarkers largely drive this risk, prediabetes serves as a clinically meaningful modifier that may amplify vulnerability to myocardial dysfunction.”
“Using heart failure biomarkers, we can identify and treat these patients who have a much higher risk of cardiovascular disease, but this also means we can look at biomarkers for other cardiovascular events. The prediabetes state is often overlooked in patients, but by defining vulnerable subpopulations, we can take preventive actions to care for patients before emergencies occur.”
“We already know there's a link between prediabetes and heart failure. But we wanted to see if additional factors, such as subclinical heart injury or stress, could elevate the risk of developing heart failure beyond prediabetes alone.”
The coexistence of prediabetes and malignant left ventricular hypertrophy identifies a subgroup of hypertensive adults at substantially elevated risk for incident heart failure, highlighting the value of integrating metabolic and cardiac structural markers in risk assessment.
BACKGROUND: Prediabetes is common among adults with hypertension, but its contribution to heart failure (HF) risk, particularly in the presence of subclinical myocardial abnormalities, remains uncertain. OBJECTIVES: The objective of the study was to assess whether prediabetes combined with malignant left ventricular hypertrophy (LVH)-defined as LVH accompanied by subclinical myocardial injury or stress-is associated with increased HF risk in hypertensive adults without diabetes. METHODS: This prospective cohort analysis included 8,131 hypertensive adults without diabetes or prior HF from the SPRINT (Systolic Blood Pressure Intervention Trial). LVH was defined using the Cornell voltage product. Subclinical myocardial injury was defined as high-sensitivity cardiac troponin I ≥6 ng/L (men) or ≥4 ng/L (women), and subclinical myocardial stress as N-terminal pro-B-type natriuretic peptide ≥125 pg/mL. Cox proportional hazards models estimated adjusted HRs and 95% CIs for HF. RESULTS: During a median 3.3-year follow-up, 115 HF events occurred. Compared with normoglycemic adults without malignant LVH, those with both prediabetes and malignant LVH had higher HF risk (adjusted HR: 3.55; 95% CI: 1.98-6.36). Similar patterns were observed for prediabetes with LVH plus myocardial injury (HR: 4.02; 95% CI: 2.21-7.30) or stress (HR: 4.04; 95% CI: 2.22-7.34). Prediabetes alone was not associated with HF (adjusted HR: 1.24; 95% CI: 0.80-1.91). CONCLUSIONS: Among hypertensive adults, the coexistence of prediabetes and malignant LVH identifies a subgroup at substantially elevated HF risk. Integrating glycemic status, ECG findings, and cardiac biomarkers may enhance HF risk stratification and inform preventive strategies.
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Kazé et al. (2026) conducted a cohort in Hypertension without diabetes (n=8,131). Prediabetes and malignant left ventricular hypertrophy vs. Normoglycemia without malignant left ventricular hypertrophy was evaluated on Incident acute decompensated heart failure (HR 3.55, 95% CI 1.98-6.36). Compared with normoglycemic adults without malignant left ventricular hypertrophy, those with both prediabetes and malignant LVH had a significantly higher risk of incident heart failure (HR 3.55).
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