{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:24:31Z","timestamp":1787757871717,"version":"build-2784847793"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Ischemic stroke (IS) related to atrial fibrillation (AF) represents a cardio-cerebral comorbidity, whereas diabetes-related IS reflects an advanced manifestation of panvascular disease. We aimed to analyze the burden trends in AF-related and diabetes-related IS, using Global Burden of Diseases 2021 data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>To quantify the burdens of AF- and diabetes-related IS, we applied the population-attributable fraction, the proportion of burden preventable by eliminating a risk factor. We calculated population-attributable fractions stratified by time, location, and age group. We analyzed the burdens using joinpoint regression, time-series projection to 2050, and age\/sex-stratified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Globally, AF-related IS had a higher age-standardized incidence rate in 1990 but declined steadily (average annual percentage change =\u20130.81 [95% CI, \u20130.92 to \u20130.69]). Conversely, diabetes-related IS, despite a lower initial incidence, exhibited substantial and sustained increases (average annual percentage change=1.10 [95% CI, 1.02\u20131.18]). Middle-high socio-demographic index regions experienced the greatest burden from both comorbidities. In North America and Eastern Europe, the age-standardized incidence rates of AF-related IS stabilized (average annual percentage change=\u20131.45 [95% CI, \u20131.63 to \u20131.27]; \u20130.95 [95% CI, \u20131.06 to \u20130.84]), whereas the age-standardized incidence rates of diabetes-related IS continued to increase (average annual percentage change=1.18 [95% CI, 1.02\u20131.34]; 0.72 [95% CI, 0.56\u20130.88]). High body mass index emerged as a critical shared risk factor for AF, diabetes, and IS. Projections indicate a substantial increase in diabetes-related IS incidence over the next 3 decades, contrasting with minimal growth in AF-related IS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>IS remains a critical global health challenge, primarily driven by the rising burden of diabetes-related IS. Our findings highlight the importance of age- and country-specific interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.054141","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T09:00:56Z","timestamp":1784278856000},"page":"2754-2767","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Global Trends in the Burden of Ischemic Stroke Attributable to Diabetes Versus Atrial Fibrillation"],"prefix":"10.1161","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3527-7865","authenticated-orcid":true,"given":"Liuding","family":"Wang","sequence":"first","affiliation":[{"name":"Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing (L.W., Y.C., X.L., Y.Z., J.L.)."},{"name":"Department of Neurology (L.W., X.L., Y.Z., J.L.), Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8705-2652","authenticated-orcid":true,"given":"Fa","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (F.L., R.L., X.C.), Beijing Tiantan Hospital, Capital Medical University, China."},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (F.L., R.L., X.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Chen","sequence":"additional","affiliation":[{"name":"Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing (L.W., Y.C., X.L., Y.Z., J.L.)."},{"name":"Department of Cardiology (Y.C.), Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Liang","sequence":"additional","affiliation":[{"name":"Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing (L.W., Y.C., X.L., Y.Z., J.L.)."},{"name":"Department of Neurology (L.W., X.L., Y.Z., J.L.), Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0894-7867","authenticated-orcid":true,"given":"Li","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (L.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3482-4489","authenticated-orcid":true,"given":"Tzak Sing","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School (T.S.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lelin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runting","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (F.L., R.L., X.C.), Beijing Tiantan Hospital, Capital Medical University, China."},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (F.L., R.L., X.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Liu","sequence":"additional","affiliation":[{"name":"Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing (Y.L., Y.X.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James Tin Fong","family":"Zhuang","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, China (J.T.F.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanming","family":"Xie","sequence":"additional","affiliation":[{"name":"Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing (Y.L., Y.X.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunling","family":"Zhang","sequence":"additional","affiliation":[{"name":"Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing (L.W., Y.C., X.L., Y.Z., J.L.)."},{"name":"Department of Neurology (L.W., X.L., Y.Z., J.L.), Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0051-3303","authenticated-orcid":true,"given":"Mario","family":"Teo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, North Bristol NHS Trust, United Kingdom 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