Routine Blood Markers Predict Heart Failure Risk in Prediabetes

Heart failure prevention relies on finding high-risk adults before symptoms appear, yet effective stratification remains difficult in routine care. Prediabetes affects an estimated 115.2 million U.S. adults as of January 2026 and is broadly linked to cardiovascular complications. Coexisting hypertension and silent cardiac injury or stress further complicate risk assessment. A new study shows that common blood biomarkers can identify a subgroup with markedly elevated risk of heart failure.

Researchers at Johns Hopkins Medicine (Baltimore, MD, USA) led an analysis demonstrating that elevated high-sensitivity cardiac troponin I (hs-cTnI) or N-terminal pro–B-type natriuretic peptide (NT-proBNP) identifies adults with both prediabetes and hypertension who face substantially higher risk of heart failure (HF). The work, published in JAMA Cardiology on January 14, highlights a readily accessible approach using routine blood tests. The National Institutes of Health–funded investigation underscores an overlooked population that can be flagged before clinical events occur.

Image: The findings identify an overlooked group of at-risk adults with prediabetes using common cardiac biomarkers (photo courtesy of Adobe Stock)

The investigators defined prediabetes as fasting blood glucose of 100–125 milligrams per deciliter. Subclinical myocardial injury was defined as hs-cTnI ≥6 nanograms per liter in men or ≥4 nanograms per liter in women. Subclinical cardiac stress was defined as NT-proBNP ≥125 picograms per milliliter. Hazard ratios were calculated to compare HF incidence based on biomarker status at baseline and changes over time.

Using data from the Systolic Blood Pressure Intervention Trial (SPRINT), the team analyzed 8,234 participants ages 50 and older (mean 68 years) without diagnosed diabetes (62.9% male, 37.1% female). Two analyses were performed: outcomes by baseline biomarker levels and outcomes by biomarker changes at 12 months. At baseline, 39.7% had prediabetes, 35.7% had subclinical injury, and 43.6% had subclinical stress, with a median follow-up of 3.2 years.

Participants with baseline prediabetes plus either subclinical injury or stress were overall 10 times more likely to experience HF. By comparison, those without prediabetes but with injury or stress had moderate risk increases (hazard ratios 3.28 and 3.78, respectively). Over time, individuals with prediabetes and a ≥25% rise in hs-cTnI or NT-proBNP were 3.05 and 2.39 times more likely to develop HF, compared with 2.60 and 1.66 among those without diabetes; prediabetes alone was not linked to risk change. The authors conclude that routine biomarker testing could help target preventive interventions in this group.

“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,” said Justin Basile Echouffo Tcheugui, M.D., Ph.D., associate professor of medicine at the Johns Hopkins University School of Medicine.

“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,” said Echouffo Tcheugui.

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