Hassanain Toma, MD

Xu WH, Dong C, Rundek T, Elkind MSV, and Sacco RL. Serum Albumin Levels Are Associated With Cardioembolic and Cryptogenic Ischemic Strokes: Northern Manhattan Study. Stroke. 2014

The Northern Manhattan Study (NOMAS) is
 a prospective cohort study designed to determine stroke incidence, risk factors, and prognosis in a multiethnic urban population in northern Manhattan, NY. Xu, et al. investigated the association between serum albumin (SA) levels and ischemic stroke etiologies in this population. They stratified SA levels according to tertiles. Patients with serum albumin levels in the bottom tertile (2.7-4.2 g/dL) had an increased risk of all stroke (HR 1.76), ischemic stroke (HR 1.67), cardioembolic stroke (HR 1.92) and cryptogenic stroke (HR 2.59) than those within the top tertile (4.6-5.5 g/dL). However, SA levels were not associated with large vessel or lacunar stroke.

The authors demonstrated an association between low SA levels and ischemic strokes (cardioembolic and cryptogenic subtypes). This is interesting because Copenhagen City Heart Study and the Framingham offspring study reported an association between low SA and heart disease (atrial fibrillation, myocardial infarction, and heart failure). Could SA be the new biomarker for identifying patients at risk of cardioemblic stroke and cryptogenic strokes? I think it’s only a matter of time that someone decides to perform an individual patient-level data meta-analysis to better study this association.

In the meantime, I leave you with this thought: Would you anticoagulate cryptogenic stroke patients with low SA levels and a negative 30-days cardiac monitoring?