What to Know About Prediabetes, Prehypertension, and Other Prediseases
Here's what you can do if you're told you have one of these conditions
When you get a health screening—for high blood pressure or diabetes, for example—you might be told you have prehypertension or prediabetes. But what does that mean?
What is sometimes called a “predisease” is diagnosed when a screening result isn’t quite normal but is below the threshold for disease.
Ignoring a troubling sign, such as rising blood pressure, can be dangerous. But treatment—especially if your numbers are borderline—can come with risks that outweigh the benefits. “There’s a very large pool of people that fit in these predisease ranges who quite likely will never go on to have any serious health consequences at all,” says Jenny Doust, Ph.D., a professor of clinical epidemiology at Bond University in Queensland, Australia.
Here, what you need to know about these so-called prediseases—and what you can do about them.
What is it? Prediabetes means your blood sugar levels are higher than normal but not as high as in full-blown type 2 diabetes.
What is it? Although the American Heart Association doesn’t use the term anymore, prehypertension used to be defined as systolic blood pressure (the top number) of 120 to 139 mm Hg and diastolic (the bottom number) of 80 to 89 mm Hg. Guidelines from the AHA, updated in 2017, have reclassified blood pressure of 120 to 129 over 80 mm Hg as “elevated” and 130 to 139 over 80 to 89 mm Hg as “Stage 1 hypertension.”
How serious is it? According to the CDC, 1 in 3 Americans could be classified as having elevated or Stage 1 hypertension. For older adults in that category, the rate of progression to Stage 2 hypertension (140/90 mm Hg or greater) may be as high as 50 percent over four years.
What should you do? Measuring blood pressure outside a doctor’s office is a key step to confirm your reading, says Anthony Viera, M.D., M.P.H., chairman of the department of community and family medicine at the Duke University School of Medicine.
Whether or not your blood pressure is elevated or at Stage 1, making lifestyle changes is the first step. Regular exercise, losing weight, quitting smoking, drinking less alcohol, and following the DASH diet—which calls for fruit, veggies, and whole grains, and less saturated fat and sodium—can help.
The new guidelines recommend considering medications for Stage 1 hypertension only if a person is at high risk for a heart attack or stroke because of other factors. And the American College of Physicians recommends blood pressure meds for people 60 and older only if their systolic pressure is 150 mm Hg or higher.
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What is it? Osteopenia is defined as bone density below normal but above the threshold for osteoporosis, a condition in which bones become weaker and are at greater risk of breaking.
How serious is it? More than 43 million adults may have osteopenia. But a 2012 analysis of 4,957 older women found that after 15 years, only 5 percent of those with mild osteopenia developed osteoporosis. (It took just one year for 10 percent of those with more advanced osteopenia to progress to osteoporosis.) Also keep in mind that bone density is a relatively weak risk factor for fractures, says Teppo Järvinen, M.D., Ph.D., a professor of orthopedics at the University of Helsinki in Finland. In fact, according to a 2019 study, only 16 percent of fractures in women were due to osteoporosis.
What should you do? The U.S. Preventive Services Task Force recommends a baseline bone density scan for women 65 and older (and for young women at increased risk). Whatever the results, you can build bone mass without meds. Weight-bearing physical activity—including walking, jogging, and strength training—encourages bone growth, while smoking depletes bone. Get plenty of vitamin D and calcium in your diet from foods such as fatty fish, fortified dairy, and dark, leafy greens.
Think broadly about preventing falls, too, Järvinen says. Fix hazards at home, such as loose rugs.
What About Precancer?
If you’ve ever had a cervical lesion or colon polyp removed or destroyed as a result of a routine cervical or colon cancer screening, then you’ve been treated for a potential precancer. For those two diseases, robust evidence shows that treating the predisease has substantial benefits. But with other cancers, the benefit of catching lesions while they’re still very small isn’t as clear.
Research suggests, for example, that ductal carcinoma in situ, or precancer of the breast, progresses to invasive cancer in only about 20 to 25 percent of cases. That means it’s possible to receive treatment for something that would never harm you during your lifetime.
Scientists often can’t predict which early stage cancers or precancers will go on to cause harm. But more screening can increase your chances of being treated for a precancer that ultimately won’t hurt you.
Following official guidelines can help. The U.S. Preventive Services Task Force doesn’t recommend any routine thyroid and prostate cancer screening for most people. And many women may not need to start mammography screening until age 50. Talk with your doctor about your cancer risk factors, and what kind of screening regimen makes sense for you.
Other Prediseases to Know
Dyslipidemia. If your LDL (or bad) cholesterol is 130 or higher, that’s called dyslipidemia, an abnormal amount of fats in blood. And although cholesterol-lowering drugs can help reduce your risk of heart disease, your LDL level on its own isn’t the only consideration. Instead, says Douglas DeLong, M.D., chair of the Board of Regents of the American College of Physicians, your doctor should calculate your overall risk of having a heart attack or stroke in the next 10 years. If your risk is low, then exercise, weight loss, and an improved diet are your best bet.
Predementia. Mild cognitive impairment (MCI) can sometimes signal the beginning stages of dementia. Screening is covered by Medicare on the theory that being forewarned could help people prepare. But many people with MCI never develop dementia and may even revert to normal cognition. There’s also no known treatment that can stop cognitive decline. That means a diagnosis could simply cause you anxiety in exchange for no benefit.