{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:52:50Z","timestamp":1791355970102,"version":"4.3.1"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Stroke burden varies across the Americas, yet data on modifiable risk factor contributions remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Using GBD (Global Burden of Disease) study 2021 data, we analyzed stroke mortality and disability\u2010adjusted life\u2010year (DALY) rates attributable to 23 modifiable risk factors across 39 countries and territories in the Americas. Age\u2010standardized rates were compared by sex, stroke subtype, region, and Socio\u2010Demographic Index; age\u2010specific estimates used 5\u2010year groups (25\u201395+ years). Trends were assessed using average annual percentage change (AAPC) from Joinpoint regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">In 2021, 78.8% (95% uncertainty interval, 70.1%\u201385.9%) of stroke deaths and 76.9% (68.2%\u201383.6%) of DALYs were attributable to the 23 risk factors combined. High systolic blood pressure was the leading contributor, accounting for 20.87 attributable deaths (95% uncertainty interval, 15.17\u201325.80) and 453.30 DALYs (333.16\u2013556.41) per 100\u2009000, representing 54.8% of deaths and 52.2% of DALYs. From 1990 to 2021, the largest reductions occurred for household air pollution from solid fuels (deaths AAPC, \u22125.09% [95% CI, \u22125.17 to \u22125.02]; DALYs AAPC, \u22124.92% [\u22124.98 to \u22124.86]) and secondhand smoke (deaths AAPC, \u22123.45% [\u22123.49 to \u22123.41]). Reductions were minimal for high body mass index (deaths AAPC, \u22120.54% [\u22120.59 to \u22120.49]; DALYs AAPC, \u22120.42% [\u22120.46 to \u22120.37]), high fasting plasma glucose (deaths AAPC, \u22121.10% [\u22121.14 to \u22121.06]), and dietary risks; high body mass index burden increased in the Caribbean, notably in Haiti and the Dominican Republic. Stroke deaths attributable to high temperature increased &gt;3.5% annually (AAPC) in Panama, Jamaica, and the Dominican Republic. High systolic blood pressure burden remained highly unequal, with age\u2010standardized death rates of 10.42 per 100\u2009000 in high\u2013Socio\u2010Demographic Index versus 109.33 in low\u2013Socio\u2010Demographic Index countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Stroke burden attributable to modifiable risk factors declined overall, but marked disparities persisted. High systolic blood pressure remained dominant, whereas stalled or increasing burden from obesity, metabolic, and dietary risks highlights the need for equity\u2010focused prevention across the Americas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047114","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:38:56Z","timestamp":1790311136000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Stroke Burden Attributable to Risk Factors in the Americas, 1990 to 2021: A Temporal Trends Analysis From the GBD Study 2021"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1307-9355","authenticated-orcid":false,"given":"Felipe","family":"Fregni","sequence":"first","affiliation":[{"name":"Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School","place":["Boston"]},{"name":"Harvard University","place":["Boston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassel","family":"Almarie","sequence":"additional","affiliation":[{"name":"Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School","place":["Boston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0641-0206","authenticated-orcid":false,"given":"Ram\u00f3n","family":"Martinez","sequence":"additional","affiliation":[{"name":"Pan American Health Organization","place":["Washington"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4300-9921","authenticated-orcid":false,"given":"Ver\u00f3nica V.","family":"Olavarr\u00eda","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Alemana de Santiago, Facultad de Medicina Cl\u00ednica Alemana Universidad del Desarrollo","place":["Santiago, Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6419-4591","authenticated-orcid":false,"given":"Carlos","family":"Abanto","sequence":"additional","affiliation":[{"name":"National Institute of Neurological Sciences","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6951-7786","authenticated-orcid":false,"given":"Matias","family":"Alet","sequence":"additional","affiliation":[{"name":"Centro Integral de Neurolog\u00eda Vascular, Fleni, Ciudad Aut\u00f3noma de Buenos Aires","place":["Buenos Aires, Argentina"]},{"name":"Hospital General de Agudos J. 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