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Prediabetes, Malignant Left Ventricular Hypertrophy, and Risk of Incident Heart Failure Among Hypertensive Adults

Arnaud D Kaze1, Stephen P Juraschek2, Jordana B Cohen3

  • 1Division of Cardiology, Department of Medicine, Banner-University Medical Center Phoenix, The University of Arizona College of Medicine-Phoenix, Arizona, USA.

JACC. Advances
|August 5, 2026
PubMed

Insights

Prediabetes combined with malignant left ventricular hypertrophy (LVH) significantly increases heart failure (HF) risk in hypertensive adults. This combination, not prediabetes alone, identifies a high-risk group for targeted prevention.

Area of Science:

  • Cardiology
  • Endocrinology
  • Preventive Medicine

Background:

  • Prediabetes is prevalent in hypertensive individuals, but its independent impact on heart failure (HF) risk, especially with subclinical cardiac abnormalities, is not fully understood.
  • Hypertension and prediabetes are significant risk factors for cardiovascular disease, necessitating a deeper understanding of their combined effects on HF development.

Purpose of the Study:

  • To investigate the association between prediabetes, malignant left ventricular hypertrophy (LVH), and incident heart failure (HF) risk.
  • To determine if prediabetes exacerbates HF risk in hypertensive adults with LVH, defined by subclinical myocardial injury or stress.

Main Methods:

  • Prospective cohort analysis of 8,131 hypertensive adults without diabetes from the SPRINT trial.
  • Left ventricular hypertrophy (LVH) assessed via Cornell voltage product; subclinical myocardial injury by troponin I levels; subclinical myocardial stress by NT-proBNP levels.
  • Cox proportional hazards models used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for HF events.

Main Results:

  • A total of 115 HF events occurred during a median follow-up of 3.3 years.
  • Hypertensive adults with both prediabetes and malignant LVH exhibited a 3.55-fold increased risk of HF compared to normoglycemic individuals without malignant LVH.
  • Prediabetes combined with LVH and myocardial injury or stress showed HRs of 4.02 and 4.04, respectively; prediabetes alone did not significantly increase HF risk (HR: 1.24).

Conclusions:

  • The coexistence of prediabetes and malignant LVH identifies a high-risk subgroup for heart failure among hypertensive adults.
  • Integrating glycemic status, ECG-derived LVH, and cardiac biomarkers can improve HF risk stratification and guide preventive interventions.
Abstract

Keywords:
NT-proBNPheart failurehigh-sensitivity troponinhypertensionleft ventricular hypertrophyprediabetes

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