Serum Albumin Levels Are Associated With Cardioembolic and Cryptogenic Ischemic Strokes

BACKGROUND AND PURPOSE: Low serum albumin concentrations have been associated with increased stroke risk, but the underlying mechanisms are less well studied. We aimed to investigate the association between serum albumin levels and ischemic stroke etiologies in a large population-based, multi-ethnic, prospective cohort study. METHODS: Participants from the Northern Manhattan Study (n=2,986; mean age 69± 10 years) free of stroke at baseline were followed for incident stroke (a median follow-up of 12 years). Cox proportional hazard models were used to estimate the hazard ratios and 95% confidence intervals (HR, 95% CI) for baseline serum albumin levels and risk of ischemic stroke and ischemic stroke subtypes after adjusting for vascular risk factors. RESULTS: The mean baseline serum albumin level was 4.42±0.33 g/dL. There were 271 ischemic strokes during follow-up. Participants with serum albumin levels of 2.7-4.2 g/dL (the lowest tertile) had increased risk of all stroke (HR 1.76, 95% CI 1.32-2.35), ischemic stroke (HR 1.67, 95% CI 1.21-2.29), cardioembolic stroke (HR 1.92, 95% CI 1.10-3.34), and cryptogenic stroke (HR 2.59, 95% CI 1.21-5.53) than those with levels of 4.6-5.5 g/dL (the top tertile, reference). Low albumin levels (2.7-4.2 g/dL) were not associated with large vessel or lacunar stroke. CONCLUSION: Our study shows an association between low serum albumin levels and ischemic stroke, particularly cardioembolic and cryptogenic subtypes. These results suggest the potential shared pathophysiological relationship between low serum albumin levels, cardiac embolism, and cryptogenic infarction, which warrants further investigation

Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis

Background and Purpose—Atrial fibrillation (AF) confers a high risk of recurrent stroke, although detection methods and definitions of paroxysmal AF during screening vary. We therefore undertook a systematic review and meta-analysis to determine the frequency of newly detected AF using noninvasive or invasive cardiac monitoring after ischemic stroke or transient ischemic attack.<p></p> Methods—Prospective observational studies or randomized controlled trials of patients with ischemic stroke, transient ischemic attack, or both, who underwent any cardiac monitoring for a minimum of 12 hours, were included after electronic searches of multiple databases. The primary outcome was detection of any new AF during the monitoring period. We prespecified subgroup analysis of selected (prescreened or cryptogenic) versus unselected patients and according to duration of monitoring.<p></p> Results—A total of 32 studies were analyzed. The overall detection rate of any AF was 11.5% (95% confidence interval, 8.9%–14.3%), although the timing, duration, method of monitoring, and reporting of diagnostic criteria used for paroxysmal AF varied. Detection rates were higher in selected (13.4%; 95% confidence interval, 9.0%–18.4%) than in unselected patients (6.2%; 95% confidence interval, 4.4%–8.3%). There was substantial heterogeneity even within specified subgroups.<p></p> Conclusions—Detection of AF was highly variable, and the review was limited by small sample sizes and marked heterogeneity. Further studies are required to inform patient selection, optimal timing, methods, and duration of monitoring for detection of AF/paroxysmal AF.<p></p&gt