Association Between Vascular Overload Index and New-Onset Ischemic Stroke in Elderly Population with Hypertension

Background: Vascular overload index (VOI) is a marker of arterial stiffness and arteriolar resistance, which predicts the increasing risks of cardiovascular and cerebrovascular disease. This study aimed to evaluate the association between VOI and new-onset ischemic stroke in an elderly population with hypertension. Methods: This retrospective cohort study included 3315 hypertensive participants aged 60 years or more. Ischemic stroke was diagnosed according to cranial computed tomography, magnetic resonance imaging of the brain or cerebrovascular angiography. The calculation of VOI was based on systolic and diastolic blood pressure. VOI was divided by quartiles (< 7.88 mmHg, 7.88– 16.10 mmHg, 16.10– 27.14 mmHg, ≥ 27.14 mmHg) and evaluated the association with new-onset ischemic stroke by multivariable Cox regression models. Results: A total of 3315 participants (55.5% female) aged 71.4± 7.20 years were included in the analysis. The median follow-up period was 5.5 years, and 206 participants reached the endpoint, new-onset ischemic stroke. With per standard deviation increment in VOI, the risks of new-onset ischemic stroke increased in non-adjusted model (Hazard ratio [HR], 1.11; 95% confidence interval [CI]: 1.03– 1.22; p = 0.001), adjusted model (HR, 1.11; 95% CI: 1.04– 1.22; p = 0.003) and fully-adjusted model (HR, 1.15; 95% CI: 1.08– 1.26; p < 0.001), respectively. In multivariate fully adjusted model, the risks of ischemic stroke increased in higher quartiles in comparison to the first quartiles ( p for trend < 0.001). Conclusion: In an elderly hypertensive population, VOI is significantly associated with the incidence of new-onset ischemic stroke. Elevated VOI is the cardiovascular risk factor and increases the probability of new-onset ischemic stroke.