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November 2003

A Comprehensive Guide to Preventative Blood Testing
By Penny Baron

Factor VIII
Factor VIII, which is also known as antihemophiliac factor (AHF) or fibrin stabilizing factor, is a plasma coagulation protein, and is a critical cofactor in the clotting process.

Data from clinical trials have shown that persons with high levels of factor VIII are at increased risk of cardiovascular disease41 and recurrent venous thromboembolism.42 Furthermore, high levels of factor VIII were determined to be the cause, rather than a consequence, of venous thromboembolism.43

Other recent investigations support the hypothesis that there is a physiological basis to the geriatric syndrome of frailty, which is characterized as a wasting syndrome and physiological state of vulnerability to increased morbidity and mortality. Data show a significant increase in markers of inflammation (factor VIII, fibrinogen, and CRP) in the presence or absence of two prevalent chronic diseases: diabetes and cardiovascular disease. Investigators surmise that these specific physiological abnormalities “may make frail older adults more vulnerable to disease processes, functional decline, and mortality.”44

BNP (brain natriuretic peptide)
BNP is released at continuously low levels by the heart, though the rate of release may be increased by various physiological and neuroendocrine factors that regulate cardiac function. Increased levels of BNP have been associated with hypertension, congestive heart failure (CHF),45 HIV-related cardiomyopathy,46 and atherosclerosis, and is a powerful predictor of left ventricular function and prognosis.47,48

Measurement of BNP involves a relatively simple, inexpensive blood test that is able to diagnose CHF in 15 minutes. CHF is the fourth leading cause of hospitalization in the U.S., and the leading cause of hospitalization among people over age 65. Its diagnosis is sometimes difficult, with symptoms such as shortness of breath and edema (fluid retention) that are diagnostic of several conditions, and physical examinations prone to error. Although markers such as cytokines and catecholamines (stress hormones) are elevated in CHF, they are hard to measure quickly and often are not elevated until the disease becomes severe.

In a study of 250 patients with shortness of breath who were admitted to urgent care and emergency rooms, BNP measurements of 80 pg/ml were 95% accurate in diagnosing CHF, and lower values were 98% accurate in ruling out the condition. Furthermore, urgent care physicians missed 30 cases of CHF diagnosed by the cardiologists; a BNP test could have brought this figure down to one.49 One of this study’s co-authors remarked that the test has greater diagnostic accuracy than the PSA for prostate cancer, the mammogram for breast cancer, or a PAP smear for cervical cancer. Given that one study estimated that up to 20% of all CHF cases are misdiagnosed, the new test will enable urgent care physicians to provide a more rapid, accurate diagnosis for this group of patients.50

Millions of people worldwide with elevated blood glucose levels/Type II diabetes are taking either Avandia™ or Actos™ (thiazolidinediones) to control hyperglycemia. Patients with Type II diabetes are at increased risk of developing or exacerbating CHF, and treatment with thiazolidinediones such as Avandia™ or Actos™ further increases the risk.51,52

Until very recently, no way existed to identify those most likely to suffer from this devastating side effect. In a recent study, however, data showed that BNP levels were a good marker of left ventricular dysfunction (LVD)/CHF induced by pioglitazone (actos). The investigators concluded that Type II diabetes patients treated with pioglitazone (Actos™) who had elevated BNP levels prior to the start of treatment should be carefully monitored using regular BNP testing to avoid the adverse effects of CHF.53


The selenium test is used to monitor occupational exposure to selenium and detect deficiencies in the serum.

An essential trace mineral, selenium is necessary for normal functioning of the immune system and thyroid gland, and helps protect cells against free radicals that can damage cells, contribute to chronic diseases, and promote cancers. The amount of selenium contained in plant foods is determined by soil content (e.g., high in the Dakotas, very low in some parts of China and Russia). Brazil nuts, walnuts, and bread (in the U.S.) are high in selenium, as is meat from animals that eat grains or plants grown in selenium-rich soils. The current RDA is 55 mcg for men and women, 60 mcg for pregnant women, and 70 mcg for women who are lactating. One ounce of brazil nuts supply 840 mcg of selenium.

Selenium deficiency, common in areas with selenium-deficient soil, may lead to Keshan Disease (enlarged heart and poor heart function). Low levels are also seen in patients on TPN (total parenteral nutrition) and patients with malabsorption problems (severe gastrointestinal disorders). Deficiencies can also affect thyroid function.

Studies indicated that the incidence of death from cancers (lung, colorectal and prostate) is lower among people with higher blood levels of selenium.54-60 Furthermore, areas of the US with selenium-deficient soils have higher rates of nonmelanoma skin cancer.61

Low levels of selenium may also be associated with an increased risk of heart disease, rheumatoid arthritis, and HIV/AIDS.

Selenium levels should be tested in anyone who suspects occupational exposure (toxic levels) and monitored in those living in areas of selenium-deficient soil, as well as anyone with risk of (or who already has) heart disease, cancer, or arthritis.

Vitamin B12 and Folate
Vitamin B12, found only in animal source foods, is necessary for the formation and regeneration of red blood cells. It also promotes growth and increases appetite in children, increases energy, and helps maintain a healthy nervous system. Elderly people suffering from neurological impairment find that B12 supplementation improves their cognitive function.

Folic acid helps protect against chromosomal (genetic) damage; prevents atherosclerosis caused by excess homocysteine; in high doses has been shown to decrease risk of cardiovascular disease; is needed for the utilization of sugar and amino acids; may prevent some types of cancer; promotes healthier skin; and helps protect against intestinal parasites and food poisoning. It has also been established that folic acid can prevent spina bifida; therefore, women of childbearing age should increase their RDA of folic acid.