Think prediabetes is mild? Think again: Doctor warns how it may damage your heart

Many people breathe a sigh of relief when a medical report shows prediabetes rather than diabetes. The term often sounds mild, even temporary. But doctors are increasingly warning that this assumption can be dangerously misleading. According to Dr Sudhir Kumar from Apollo Hospital Hyderabad, the metabolic changes that begin during prediabetes may already be affecting blood vessels and increasing the risk of serious cardiovascular problems long before diabetes is formally diagnosed.

Dr Kumar recently highlighted the issue on X, drawing attention to what he described as a silent combination: prediabetes and obesity. In his explanation, he pointed out that many people dismiss prediabetes simply because it is not yet classified as diabetes. However, emerging research suggests that damage to the vascular system can start much earlier.

Prediabetes and cardiovascular risk

According to the doctor, prediabetes itself already raises cardiovascular risk. He shared that studies indicate that young adults with prediabetes face about a 1.7 times higher risk of heart attack compared with those who have normal glucose levels. The risk becomes even more concerning when other factors are present. For example, when prediabetes is combined with habits like smoking, the likelihood of stroke in young adults can rise more than threefold.

Prediabetes and obesity: Bad combo

Another reason the condition can be dangerous is that it rarely exists on its own. Dr Kumar noted that prediabetes is often accompanied by obesity and high cholesterol, both of which significantly accelerate vascular disease. Because of this combination, cardiovascular problems may begin developing years before someone is ever diagnosed with diabetes.

Obesity, in particular, worsens the situation through several biological mechanisms. It promotes insulin resistance, a condition where the body’s cells respond poorly to insulin and struggle to regulate blood sugar effectively. At the same time, obesity triggers chronic low-grade inflammation in the body. This persistent inflammatory state can gradually damage blood vessels.

Endothelial dysfunction

The doctor also pointed to endothelial dysfunction as another consequence. The endothelium, a thin layer lining the blood vessels, plays a key role in maintaining healthy circulation. When it becomes impaired, blood vessels lose some of their ability to regulate blood flow properly. Over time, these changes contribute to the faster buildup of fatty plaques in arteries, a process known as atherosclerosis.

Together, these processes accelerate vascular ageing, meaning blood vessels begin to behave like those of an older person much earlier in life. Importantly, Dr Kumar stressed that this growing risk is not limited to older adults. Increasingly, heart attacks and strokes are being reported in people under the age of 45. In many of these cases, metabolic risk factors such as obesity, hypertension, and diabetes play a central role.

Because of this trend, the doctor urged people to reconsider how they view prediabetes. Instead of treating it as a mild or harmless stage, he described it as an early warning signal that the body’s cardiovascular system may already be under stress.

At the same time, he highlighted an important reason for optimism. Prediabetes remains one of the most reversible metabolic conditions. With weight loss, regular physical activity, and healthier dietary habits, blood glucose levels can often return to normal while also lowering the risk of future cardiovascular disease.