Objective:

To examine associations between novel metaflammation indices (LHR, MHR, NHR, PHR) and first stroke risk in community-dwelling older adults, and assess their differences across Traditional Chinese medicine (TCM) constitution types.

Key Findings:

• 36 incident stroke cases were recorded during the follow-up period.
• LHR (HR = 1.68, 95% CI: 1.09–2.61) and PHR (HR = 1.01, 95% CI: 1.00–1.01) were significantly positively associated with stroke risk in the overall population.
• Individuals with high-risk biased constitutions had a significantly elevated stroke risk (HR = 3.42, 95% CI: 1.32–8.80).
• Associations of LHR and PHR with stroke were significant in balanced and low-risk biased constitution subgroups, but not in high-risk biased constitution subgroup.

Interpretation:

LHR and PHR may be associated with incident stroke in community-dwelling older adults, with variations across TCM constitution types.

Limitations:

• No significant interaction observed, indicating cautious interpretation of variations.
• Retrospective design may limit causal inferences.

Conclusion:

Integrating traditional risk factors, metaflammation indices, and TCM constitution identification might contribute to a more refined stroke risk assessment strategy.