Which blood tests does your cardiologist order?

Reinhard Böhmer

• Blood tests are used for many purposes in the diagnosis of heart disease.

• Here are some of the most common tests and what they are used for.

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Introduction

•Cardiac biomarkers •Lipid blood tests•Lipoprotein, homocysteine and fibrinogen •C-reactive protein•Blood tests for anticoagulants•Blood sugar •B-type natriuretic peptide test•Electrolytes •Blood count

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• Cardiac biomarkers. These tests are used to diagnose a heart attack by determining if heart cells have been damaged.

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• Lipid blood tests. Provides information on your levels of cholesterol and triglycerides, which are associated with risk of heart disease.

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• Lipoprotein, homocysteine and fibrinogen tests. These blood tests help to determine your risk of developing coronary heart disease.

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• C-reactive protein. A blood test that identifies high levels of inflammation and an increased risk for heart disease.

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• Blood tests for anticoagulants. These tests help your doctor to determine if you are taking a safe level of blood thinners for e.g. INR and PTT

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• Blood tests for anticoagulants. These tests help your doctor to determine if you are taking a safe level of blood thinners for e.g. INR and PTT

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• Blood sugar tests. Several different tests are used to determine if you have diabetes, how severe your diabetes has been and whether or not your diabetes treatment is effective.

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•Glucose•HbA1C

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• B-type natriuretic peptide test. This blood test helps doctors to identify and determine the severity of heart failure.

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• Electrolyte tests. Used to determine the effectiveness of various treatments and also to detect liver, heart and kidney disease e.g. sodium, potassium ad chloride.

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• Blood count. Used to diagnose and monitor various heart conditions and the effectiveness of drugs or other treatments.

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Vitamin D

• Vitamin D plays a major role in bone mineral density and calcium homeostasis.

• The active form of Vitamin D influences the adaptive and immune functions through Vitamin D receptor (VDR) that are present in various cells of the immune system.

• The presence of adequate levels levels of vitamin D and calcitriol keeps the T cells from attacking the body’s own tissues.

• Vitamin D deficiencies have been associated with development of tuberculosis disease, caused by Mycobacterium tuberculosis.

• This is one of the most common infections in Southern Africa!

• Calcitriol (1,25-dihydroxyvitamin D3), the biologically most active form of vitamin D, maintains calcium homeostasis through its actions in intestine, bone, kidneys, and the parathyroid glands.

• In recent years it has been recognized that calcitriol exerts antiproliferative and prodifferentiating effects in many malignant cells, and retards the development and growth of tumors in animal models raising the possibility of its use as an anticancer agent.

• Deeb KK, Trump DL, Johnson CS. Vitamin D signalling pathways in cancer:• potential for anticancer therapeutics. Nat Rev Cancer 2007;7(9):684–700.

Disease asscociations• Skeletal health • Cancer • Multiple sclerosis • Macular degeneration • Atopic dermatitis • Melanoma • Hypertension • Colorectal cancer • Cardiovascular disease • Diabetes mellitus type 2 • Rarer cancers are endometrial, esophageal, gastric, kidney,

ovarian, and pancreatic cancers, and non-Hodgkin lymphoma• Depression

Vitamin D levels

• "Serum 25(OH)D levels are inversely associated with recent URTI," the study authors write. "This association may be stronger in those with respiratory tract diseases. Randomized controlled trials are warranted to explore the effects of vitamin D supplementation on RTI"

Arch Intern Med. 2009;169:384-390

• Studies from Santiago (Chile), Kashmir (India), and East Asia reported that more than 50% of individuals living in areas with sunny climates had inadequate serum vitamin D levels

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• In summary, most available evidence indicates that there is an inverse association between skin pigmentation and serum 25(OH)D levels.1-8,29-36

• The authors concluded that to maintain serum 25(OH)D levels of greater than 30 ng/mL,individuals of European ancestry with high sun exposure need a supplemental dietary intake of 1300 IU/d of vitamin D, whereas individuals of African ancestry with low sun exposure need 2100 to 3100 IU/d year round.

Dietary Intake

• Recommended dietary allowances (RDAs) for adults and allowable intake (AI) levels for vitamin D:

• 0 to 12 months of age, 400 IU/d;• between 1 and 70 years of age, 600 IU/d;• older than 70 years, 800 IU/d. • pregnant and lactating women was also set at

600 IU/d.

Dietary Intake

•Upper intake levels (the highest daily intake likely to pose no risk) were as follows:• for 1 to 3 years of age, 2500 IU/d; •for 4 to 8 years of age, 3000 IU/d; •9 years and older, 4000 IU/d.

Indications for Vitamin D determination

• Riskgroups between May and September• Older patients, tumor diseases, risk for

osteoporosis, Females with oestradiol values below 15 pg/ml, Sunlight deficit

• Annormal Calcium values,Malabsorptionssyndrome, anti-epileptic therapy, rickets, osteomalacia, kidney insufficiency