“It’s not the blood sugar itself that raises the cardiovascular risk, but it’s the other risk factors that are quite prominently associated with prediabetes, just like they are with diabetes,” says Om Ganda, M.D., medical director of the Lipid Clinic at Joslin Diabetes Center and associate clinical professor of medicine at Harvard Medical School.

The risk is especially pronounced in the years immediately following a diagnosis of prediabetes. “The first five years are crucial because that’s when those who are going to get cardiovascular disease may get it,” Ganda says. “If you do nothing about prediabetes — and this has been studied very well — the risk of developing cardiovascular disease is about 10 to 11 percent per year. So in the first five years after diagnosis, your chance of developing cardiovascular disease is about 50 percent.”

Problem is, 88 million adults in the U.S. have prediabetes and 84 percent of them don’t know it. So the overwhelming majority of people with prediabetes are missing out on their best window of opportunity to slow the progression of the disease and the complications that go along with it. “Diabetes affects almost every system in the body — not just the cardiovascular system, but the kidneys, eyes, even the brain,” Ganda says. “The longer it takes to act, the harder it becomes to reverse course.”

Of the new diabetes drugs with cardiovascular benefits, none is approved for use in people with prediabetes. However, new research shows that two drugs, Farxiga and Jardiance, lower the risk of cardiovascular death or hospitalization for heart failure in people with or without diabetes.

But that doesn’t mean these or any of the new drugs are for everyone. (See “Diabetes drugs with heart-health benefits.”) For one thing, they’re still quite expensive, Ganda notes. And, like all drugs, they have side effects, some of them significant. In the end, say experts, the real prescription for both prediabetes and type 2 diabetes — and by extension cardiovascular disease — may not come in a bottle.

Losing weight and exercise are the two most effective means of reducing risk for cardiovascular disease, particularly if you have prediabetes,” Stein says. “That improves everything: glucose metabolism, blood pressure, cholesterol and triglycerides. Not to mention the fact that if you lose weight, that puts less stress on your bones and joints so you can move around easier — and there’s less stress on your heart.” Plus, these new drugs “don’t work that well unless you’re also on a good lifestyle regimen,” he hastens to add. “A good lifestyle regimen supercharges how beneficial they are.”