{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T08:42:51Z","timestamp":1782981771939,"version":"3.54.5"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec id=\"jah311030-sec-0001\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Female sex has historically been associated with higher risk of ischemic stroke in patients with atrial fibrillation. However, contemporary European studies suggest this association may have attenuated and become nonsignificant over recent years. This study aims to characterize temporal trends in cardiovascular outcomes in a large, global cohort of patients with atrial fibrillation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah311030-sec-0002\" xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">Nonanticoagulated patients with newly diagnosed atrial fibrillation were identified from a global federated research network (TriNetX) between 2000 and 2019. One\u2010year ischemic stroke risk and risk ratios were calculated for women versus men. Secondary outcomes included all\u2010cause death, myocardial infarction, heart failure, and dementia. Cohorts were compared before and after adjustment for age and comorbidities.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah311030-sec-0003\" xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Overall, 1\u2009204\u2009852 patients were included (44% women). Unadjusted risk of ischemic stroke increased in women (1.75% to 4.24%) and men (1.13% to 3.55%) from 2000\u20132004 to 2015\u20132019, while all\u2010cause death decreased over the same periods (women, 10.36% to 7.79%; males, 10.76% to 7.59%). After adjustment, female sex remained independently associated with higher risk of ischemic stroke, although the risk decreased over time (2000\u20132004: risk ratio, 1.54 [95% CI, 0.94\u20132.51]; 2015\u20132019: risk ratio, 1.09 [95% CI, 1.06\u20131.13]). After adjustment, male sex was associated with risk of all\u2010cause death and myocardial infarction, while risk of dementia and heart failure was similar between sexes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah311030-sec-0004\" xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Between 2000 and 2019, the risk of ischemic stroke increased among nonanticoagulated patients with atrial fibrillation. While the association between female sex and ischemic stroke decreased over time, female sex remained associated with a higher stroke risk in 2015 to 2019 after adjustment.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.040325","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:01:47Z","timestamp":1750723307000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Temporal Trends in the Association Between Female Sex and Ischemic Stroke Among Patients With Atrial Fibrillation"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5425-7739","authenticated-orcid":false,"given":"Mark T.","family":"Mills","sequence":"first","affiliation":[{"name":"Liverpool John Moores University and Liverpool Heart and Chest Hospital","place":["Liverpool, UK"]},{"name":"Liverpool Heart and Chest Hospital NHS Foundation Trust","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2895-6234","authenticated-orcid":false,"given":"Tommaso","family":"Bucci","sequence":"additional","affiliation":[{"name":"Liverpool John Moores University and Liverpool Heart and Chest Hospital","place":["Liverpool, UK"]},{"name":"Sapienza University of Rome","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8401-4033","authenticated-orcid":false,"given":"Peter","family":"Calvert","sequence":"additional","affiliation":[{"name":"Liverpool John Moores University and Liverpool Heart and Chest Hospital","place":["Liverpool, UK"]},{"name":"Liverpool Heart and Chest Hospital NHS Foundation Trust","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3490-090X","authenticated-orcid":false,"given":"Dhiraj","family":"Gupta","sequence":"additional","affiliation":[{"name":"Liverpool John Moores University and Liverpool Heart and Chest Hospital","place":["Liverpool, UK"]},{"name":"Liverpool Heart and Chest Hospital NHS Foundation Trust","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool John Moores University and Liverpool Heart and Chest Hospital","place":["Liverpool, UK"]},{"name":"Liverpool Heart and Chest Hospital NHS Foundation Trust","place":["Liverpool, UK"]},{"name":"Aalborg University","place":["Aalborg, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2023.100786"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-1584"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH12-03-0175"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcu054"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-1776394"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h7013"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1739411"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1055\/a-2325-5923"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.029081"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae198"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2024.100967"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae280"},{"key":"e_1_3_1_14_2","unstructured":"TriNetX . 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