Biomarkers of Subclinical Myocardial Injury and HF Risk in Adults with Prediabetes and Hypertension

An analysis of SPRINT participants with hypertension and without diabetes linked elevated biomarkers consistent with subclinical myocardial injury or stress to higher incident heart failure risk when prediabetes was present. The report centers on high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro–B-type natriuretic peptide (NT-proBNP), describing relative differences in heart failure risk over follow-up rather than diagnostic performance.

Investigators analyzed data from 8,234 adults aged 50 years and older without diabetes (mean age 68 years) and followed them for a median of 3.2 years. Baseline biomarker values and 12-month biomarker changes were evaluated in relation to incident heart failure, with prediabetes defined as fasting glucose 100–125 mg/dL. Subclinical myocardial injury was defined using sex-specific hs-cTnI thresholds (≥6 ng/L for men and ≥4 ng/L for women), and subclinical myocardial stress was defined as NT-proBNP ≥125 pg/mL. A ≥25% increase in biomarker concentration from baseline to 12 months defined longitudinal change. The report emphasizes relative comparisons (e.g., hazard ratios) across joint categories, allowing it to contrast baseline elevations with changes over time in relation to subsequent heart failure risk.

At baseline, the report describes participants with both prediabetes and biomarker-defined injury or stress as having the highest incident heart failure risk compared with participants with normoglycemia and no myocardial injury or stress. Specifically, prediabetes plus injury was associated with an HR of 4.20, and prediabetes plus stress with an HR of 5.20 (each compared with normoglycemia and no injury or stress). Overall, the baseline comparisons describe a step-up in reported heart failure risk when prediabetes co-occurred with biomarker-defined subclinical injury or stress.

Beyond baseline levels, the report also describes a longitudinal signal: among participants with both prediabetes and a ≥25% rise at 12 months in hs-cTnI, incident heart failure risk was higher (HR 3.05), and a comparable rise in NT-proBNP was similarly associated (HR 2.39). The longitudinal analysis is reported with a shorter median follow-up (2.3 years).

The investigators suggest that routinely available blood biomarkers could help identify prediabetic patients with higher observed risk before heart failure develops. As summarized, biomarker-defined subclinical injury or stress—and increases over time—tracked with higher incident heart failure risk in this hypertension cohort when prediabetes was present.

Key Takeaways:

• The report describes associations between hs-cTnI/NT-proBNP and incident heart failure in older adults with hypertension without diabetes.
• Reported heart failure risk was highest when prediabetes co-occurred with elevated cardiac biomarkers (HR 4.20 for injury; HR 5.20 for stress, vs normoglycemia with no injury/stress).
• Among participants with both prediabetes and biomarker increases over 12 months, rises in either biomarker were associated with higher heart failure risk (hs-cTnI HR 3.05; NT-proBNP HR 2.39).