Increased risk of stroke in possible sarcopenia patients with fall history

The risk of incident stroke in middle-aged and older patients with possible sarcopenia (PS) is higher in those with fall history than those without, according to the first study to establish fall history as a long-term stroke predictor in Asian PS cohorts.

The retrospective study, which analyzed data of 4,605 participants with PS (mean age, 64.8 years; female, 54.94 percent) from the China Health and Retirement Longitudinal Study (CHARLS) over a 3-year period (2015–2018), found that those with fall history had 37 percent higher risk of incident stroke compared with non-fallers (adjusted odds ratio [OR], 1.37; 95 percent confidence interval [CI], 1.02–1.84; stroke incidence, 9.3 vs 6.7 percent). [Exp Gerontol 2025;doi:10.1016/j.exger.2025.112835]

Subgroup analysis found lack of statistical significance (p_interaction>0.05) for association with fall history across age, sex, body mass index, education level, residence, lifestyle factors (alcohol consumption, smoking), and comorbidities (hypertension, diabetes). Significant interaction was found only with dyslipidaemia (p_interaction=0.022), suggesting a strong association between fall history and stroke risk in this subgroup.

Fall history was assessed by self-reported response to “Have you fallen in the past 2 years?” Stroke was physician-diagnosed via self-report. The authors noted that this reliance on self-reported fall history and stroke diagnosis was a limitation of the study, due to recall bias, particularly for minor falls or asymptomatic strokes.

Results of the study complement a recent US study, which documented a 2.7-fold elevation in the short-term risk of stroke (≤15 days post-fall) among emergency department patients who underwent treat-and-release protocols following a fall incident. [Stroke 2024;55:2247-2253]

The authors postulated that the association between falls and long-term risk of stroke could be attributed to chronic pathways intricately linked to sarcopenia and its associated comorbidities and their sequelae.

“Sarcopenia-induced inflammation exacerbates the systemic inflammatory response, thereby accelerating the progression of atherosclerosis.  On this pathological basis, falls, as acute stress events, induce chronic neuroinflammation, which ultimately contributes to the onset of stroke,” wrote the authors. “Second, both falls and PS share common biological links with frailty, a well-established predictor of cardiovascular disease. Frailty encompasses multiple physiological domains, including muscle mass, strength, endurance, and balance, all of which are compromised in sarcopenia and increase the risk of falls. Finally, the psychological impact of falls, manifested as fear of falling, can lead to reduced physical activity. This sedentary behaviour promotes insulin resistance and thrombogenesis, further increasing the risk of thrombotic stroke.”

PS is defined as reduced muscle strength or physical performance without low muscle mass, according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. The prevalence of PS reported in 2011 in China was 29.0 percent, indicating a substantial population vulnerable to this condition. [J Am Med Dir Assoc 2020;21:300-307.e2; Gait Posture 2024;112:147-153; J Intern Med 2024;296:156-167]  

“Our results imply that fall prevention efforts could potentially decrease stroke occurrence and foster healthier ageing among middle-aged and older adults affected by PS,” the authors concluded.