Association of biological age markers with stroke prevalence: Insights from a cross-sectional study

Stroke is a leading cause of death and disability globally, with older age significantly increasing the risk. Biological ageing, reflecting physiological decline, may better predict stroke outcomes than chronological age. However, the relationship between biological ageing markers and stroke prognosis remains unclear.

This cross-sectional study examined the associations of biological ageing markers-PhenoAge, BioAge, and their accelerations (PhenoAgeAccel, BioAgeAccel)-with stroke prevalence and all-cause mortality in 37,832 participants from the National Health and Nutrition Examination Survey (NHANES, 1999-2018). Stroke was self-reported, and biological ageing markers were calculated using established algorithms. Participants with incomplete data were excluded. Biological age accelerations (PhenoAgeAccel, BioAgeAccel) represented the difference between biological and chronological age. The main outcomes were stroke incidence and all-cause mortality, with mortality data from the NHANES linked mortality file.

Stroke patients were predominantly older, male, and more likely White. Both PhenoAge and BioAge were significantly associated with stroke risk (BioAge: OR 1.01, 95% CI 1.00-1.01, p = 0.003; PhenoAge: OR 1.04, 95% CI 1.03-1.06, p < 0.001). Accelerated ageing also increased stroke risk (BioAgeAccel: OR 1.35, 95% CI 1.15-1.58; PhenoAgeAccel: OR 1.60, 95% CI 1.38-1.85; both p < 0.001). PhenoAge showed the highest discrimination for stroke (AUC = 0.80). Accelerated ageing further predicted higher all-cause and cardiovascular mortality (PhenoAgeAccel: HR = 3.18, 95% CI 2.91-3.48, p < 0.001).

These findings suggest biological age, particularly PhenoAge and its acceleration, may enhance stroke risk stratification and management, improving clinical outcomes.