AbstractBackgroundIdiopathic normal pressure hydrocephalus (iNPH) is a clinical syndrome characterized by cognitive decline, gait disturbance and urinary incontinence. Several observational studies have indicated that iNPH patients have a high occurrence of vascular comorbidities compared to normal populations. This study aims to identify the specific vascular risk factors for iNPH and review the possible pathogenesis between vascular risk factors and iNPH development.MethodWe searched PubMed, Web of Science, Embase, and the Cochrane Library for studies that reported possible risk factors for iNPH development. Meta‐analysis of the data obtained resulted in pooled odds ratios and 95% confidence intervals.ResultThirteen studies conducted in 7 countries comprising 1350 iNPH patients and 80043 controls were included in this meta‐analysis. Our data suggest that hypertension (Pooled OR = 2.42, 95% CI 1.82 to 3.22, I2 = 61.7%), diabetes mellitus (Pooled OR = 2.91, 95% CI 2.17 to 3.92, I2 = 50.1%), coronary heart disease (Pooled OR = 1.92, 95% CI 1.02 to 3.61, I2 = 90.3%),and peripheral vascular disease (Pooled OR = 2.77, 95% CI 1.50 to 5.13, I2 = 0.0%) are important risk factors for iNPH. Overweight was also considered a possible vascular risk factor (Pooled OR = 2.01, 95% CI 1.34 to 3.04, I2 = 0.0%), but the result was not stable as demonstrated by sensitivity analysis. Hyperlipidemia, smoking, and alcohol use were not significantly associated with iNPH development.ConclusionOur meta‐analysis identified that hypertension, diabetes mellitus, coronary heart disease, and peripheral vascular disease were important risk factors for iNPH. Overweight is also considered a possible vascular risk factor, but the evidence thus far has not been robust.