Research Paper Volume 15, Issue 6 pp 2005—2032

Association between the sarcopenia index and the risk of stroke in elderly patients with hypertension: a cohort study

Xintian Cai1, *, , Junli Hu1, *, , Mengru Wang1, , Wen Wen1, , Jingyu Wang2, , Wenbo Yang1, , Yujie Dang1, , Qin Luo1, , Jing Hong1, , Nanfang Li1, ,

  • 1 Hypertension Center, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Medical Research Center for Hypertension Diseases, People’s Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang 830000, China
  • 2 Renal Division, Peking University First Hospital, Beijing 100034, China
* Equal contribution

Received: December 9, 2022       Accepted: March 6, 2023       Published: March 21, 2023
How to Cite

Copyright: © 2023 Cai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


The purpose of this study was to investigate the relationship between the sarcopenia index (SI) and stroke risk in elderly patients with hypertension. This study included 5145 stroke-free elderly hypertensive patients. We used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident stroke. Over a median follow-up of 38 months, we identified 607 (11.80%) individuals with total stroke, of whom 507 (9.85%) had ischemic stroke and 93 (1.81%) had hemorrhagic stroke. The risk of developing stroke decreased with each quartile of SI; after adjustment for multiple confounders, the HRs for the Q4 group versus the Q1 group were 0.46 (95% CI, 0.35–0.59) for total stroke, 0.46 (95% CI, 0.35–0.61) for ischemic stroke, and 0.33 (95% CI, 0.17–0.64) for hemorrhagic stroke. Restricted cubic spline analysis also demonstrated a cumulative increase in the risk of total stroke with decreases in the SI. The addition of SI to the conventional model for total stroke improved (ΔC-statistics = 0.02), an integrated discrimination improvement of 0.03 (95% CI, 0.02–0.04), and a net reclassification improvement of 0.17 (95% CI, 0.10–0.23). Similar results were observed for ischemic stroke and hemorrhagic stroke. This study found that elevated SI was negatively associated with the risk of stroke in elderly patients with hypertension. Uncovering the causality behind the relationship requires further prospective study.


SI: sarcopenia index; HRs: hazard ratios; CIs: confidence intervals; Cr: creatinine; ICD-10: International Classification of Diseases 10th Revision; FPG: fasting plasma glucose; HbA1c: hemoglobin A1c; Hcy: homocysteine; hs-CRP: high-sensitivity C-reactive protein; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; CHD: coronary heart disease; CCI: Charlson Comorbidity Index; NRI: net reclassification index; IDI: integrated discrimination index.