High blood pressure and elevated serum glucose levels often precede adverse cardiovascular events. The cardiovascular risk in otherwise healthy US adults with prehypertension (PreHTN) and/or prediabetes (PreDM), although perceived to be high, is largely undocumented. Coexisting PreHTN and PreDM in healthy US adults, correlates with untoward alterations in the commonly recognized cardiometabolic risk factors. The study investigated disease-free US adults (n=4,561) from the NHANES database (1999-2006). PreHTN and PreDM were diagnosed using JNC 7 and American Diabetes Association criteria, respectively; PreHTN was defined as systolic blood pressure 120-139 and/or diastolic blood pressure 80-89 mm Hg, and PreDM was defined as fasting blood sugar 100-125 mg dl(-1). The prevalence of coexisting PreHTN and PreDM (Co-PreHTN+PreDM) during the study period (1999-2006) was 11.2±0.6%. Prevalence increased with age, was higher in men, and was lowest in non-Hispanic Blacks. The mean systolic blood pressure was 126.0±0.5 mm Hg, diastolic blood pressure was 75.0±0.5 mm Hg and fasting blood sugar was106.3±0.3 mg dl(-1). Compared to adults with normotension, normoglycemia, subjects with Co-PreHTN+PreDM displayed adversely altered cardiometabolic risk factors. Healthy men and women with Co-PreHTN+PreDM were, on average, overweight with a large waist circumference, displayed an exacerbated systemic inflammation and higher insulin resistance. They had elevated triglycerides, lower high-density lipoprotein cholesterol, leading to above average cardiac risk ratios and were significantly more likely to have two or three concomitant metabolic risk factors. High prevalence of Co-PreHTN+PreDM in healthy US adults, a strong correlate for dysregulated cardiometabolic risk factors, highlights a plausible accelerated pathway for early cardiovascular events.