~ The 10 Most Important Blood Tests

By Penny Baron

The Life Extension Foundation receives hundreds of calls a week from people who ask, “What can I do to improve my health and longevity?” Our response is that we basically “have no idea.”

The reason we ostensibly appear so ignorant is that unless we know what your blood looks like under a microscope, there is no way for us to identify what steps you should take to protect your health and enhance your well-being.

Annual blood testing is the most important step aging adults can take to prevent life-threatening disease. With blood test results in hand, you can catch critical changes in your body before they manifest as heart disease, cancer, diabetes, or worse. Having the proper blood tests can empower you to enact a science-based disease-prevention program that could add decades of healthy life.

Sadly, most annual medical check-ups involve the physician ordering only routine blood tests, if blood tests are ordered at all. Far too often, this blood work does not even test for important markers of disease risk. The consequences of failing to analyze blood for proven markers of disease risk are needless disability and death.

Blood tests have benefits that go far beyond disease prevention. For example, by monitoring levels of sex hormones, you can take decisive steps to enhance your quality of life, perhaps by correcting a depressive mental state, erectile dysfunction, abdominal obesity, or by improving your memory and energy levels.

In this article, we discuss the 10 most important blood tests that people over the age of 40 should have each year. Armed with the results of these tests, aging adults can work together with their physicians to avert serious health problems and achieve optimal health.

1. Chemistry Panel and Complete Blood Count

The Chemistry Panel and Complete Blood Count (CBC) is the best place to begin your disease-prevention program. This low-cost panel will give you and your physician a quick snapshot of your overall health. This test provides a broad range of diagnostic information to assess your vascular, liver, kidney, and blood cell status. The Complete Blood Count measures the number, variety, percentage, concentration, and quality of platelets, red blood cells, and white blood cells, and thus is useful in screening for infections, anemias, and other hematological abnormalities.

OPTIMAL RANGES FOR POPULAR BLOOD TESTS

 

Current Laboratory Reference Range

Optimal Range

Glucose

65-99 mg/dL

70-85 mg/dL

Cholesterol

100-199 mg/dL

180-200 mg/dL

LDL

0-99 mg/dL

Under 100 mg/dL

HDL

40-59 mg/dL

Over 55 mg/dL

Triglycerides

0-149 mg/dL

Under 100 mg/dL



The Chemistry Panel provides information on the status of your cardiovascular system by testing for total cholesterol, HDL (high-density lipoprotein), LDL (low-density lipo-protein), triglycerides, and the total cholesterol/HDL ratio.1

The Chemistry Panel also measures blood glucose, which is critically important for detecting early-stage metabolic syndrome, diabetes, and coronary artery disease. In light of the rapidly growing epidemic of diabetes and other related metabolic syndromes, monitoring your fasting glucose levels is as important as knowing your cholesterol.

Also included in the Chemistry Panel is an assessment of critical minerals such as calcium, potassium, and iron.

2. Fibrinogen

An important contributor to blood clotting, fibrinogen levels increase in response to tissue inflammation. Since the development of atherosclerosis and heart disease are essentially inflammatory processes, increased fibrinogen levels can help predict the risk of heart disease and stroke.

High fibrinogen levels not only are associated with an increased risk of heart attack, but also are seen in other inflammatory disorders such as rheumatoid arthritis and glomerulonephritis (inflammation of the kidney).

In a recently published study from the University of Hong Kong Medical Center, researchers identified increased levels of fibrinogen in the blood as an independent risk factor for mortality in patients with peripheral arterial disease. When left untreated, peripheral arterial disease increases the risk of heart attack, stroke, and death. This 2005 study followed 139 men and women with peripheral arterial disease for an average of six years. Death from all causes increased with elevated fibrinogen levels: 80% of patients with a fibrinogen level above 340 mg/dL survived for less than three years. Researchers concluded that increased fibrinogen was an independent risk factor for mortality in this patient population.2

OPTIMAL RANGE OF FIBRINOGEN

Current Laboratory Reference Range

Optimal Range

193-423 mg/dL

200-300 mg/dL



In the February 2006 issue of the Journal of Thrombosis and Haemostasis, researchers reported an association between increased levels of fibrinogen and risk for venous thrombosis (blood clots).3 A recent study from Greece found an association between higher fibrinogen levels and the presence of multiple coronary lesions in patients who had suffered an acute myocardial infarction.4

A combination of lifestyle and behavioral changes — such as quitting smoking, losing weight, and becoming more physically active — may help to lower fibrinogen levels to the optimal range. Nutritional interventions may also help to optimize fibrinogen levels. You and your physician may wish to discuss the use of fish oil, niacin, and folic acid, along with vitamins A and C.

3. Hemoglobin A1C

One of the best ways to assess your glucose status is testing for hemoglobin A1C (HbA1c).5 This test measures a person’s blood sugar control over the last two to three months and is an independent predictor of heart disease risk in persons with or without diabetes.6 Maintaining healthy hemoglobin A1C levels may also help patients with diabetes to prevent some of the complications of the disease.7

According to a study published in the New England Journal of Medicine in 2005, type I diabetes patients who monitored their hemoglobin A1C (HbA1c) levels were able to achieve tight glucose control, thereby significantly lowering their risk of a cardiovascular disease event.7 Long-term elevation of blood sugar, a hallmark of diabetes, is associated with an increased risk of heart disease and stroke.

The American Diabetes Association recommends testing HbA1c levels every three to six months to monitor blood sugar levels in insulin-treated patients, in patients who are changing therapy, and in patients with elevated blood glucose levels. Since HbA1c is not subject to the same fluctuations that normally occur with daily glucose monitoring, it represents a more accurate picture of blood sugar control.8

OPTIMAL RANGE OF HEMOGLOBIN A1C

Current Laboratory Reference Range

Optimal Range

4.5-5.7%

<4.5%



In a recent study, 1,340 type I diabetic patients were followed for a total of 17 years. Patients were randomly assigned to either intensive orconventional diabetic (blood glucose) control. In the group receivingintensive treatment, hemoglobin A1C levels were significantly lower and the risk of nonfatal myocardial infarction, stroke, or death from cardiovascular disease decreased by 57%. The decrease in HbA1c values was “significantly associated with most of the positive effects of intensive treatment on the risk of cardiovascular disease.”7

Nutritional therapies may help to optimize hemoglobin A1C levels. You and your physician may wish to discuss the use of chromium, cinnamon, and coffee berry extracts.

4. DHEA

Dehydroepiandrosterone (DHEA), a hormone produced by the adrenal glands, is a precursor to the sex hormones estrogen and testosterone. Blood levels of DHEA peak in one’s twenties and then decline dramatically with age, decreasing to 20-30% of peak youthful levels between the ages of 70 and 80. DHEA is frequently referred to as an “anti-aging” hormone.

Recently, researchers in Turkey found that DHEA levels were significantly lower in men with symptoms associated with aging, including erectile dysfunction.9 Healthy levels of DHEA may support immune function, bone density, mood, libido, and healthy body composition.10

Elevated levels of DHEA may indicate congenital adrenal hyperplasia, a group of disorders that result from the impaired ability of the adrenal glands to produce glucocorticoids.11-12

Supplementation with DHEA increases immunological function, improves bone mineral density, increases sexual libido in women, reduces abdominal fat, protects the brain following nerve injury, and helps prevent diabetes, cancer, and heart disease.10

Emerging research suggests that DHEA may have antidepressant effects. In a report in the January 2006 issue of the American Journal of Psychiatry, investigators found that in HIV-infected men and women, supplementation with DHEA was superior to placebo in treating non-major depression (with a response rate of 62% vs. 33%, retrospectively).13

In another study from the National Institute of Mental Health, investigators found that DHEA significantly improved midlife-onset major and minor depression in men and women aged 45 to 65 years old.14

OPTIMAL RANGE OF DHEA IN MEN*

Standard Reference Range

Optimal Range

280-640 µg/dL

400-500 µg/dL



*Measured as DHEA Sulfate

Furthermore, a recently published study from Israel demonstrated that DHEA administration decreased self-administration of cocaine in rats, suggesting a potential for DHEA in reducing cravings and supporting recovery from addiction.15

In a recent study published in the Journal of Investigative Dermatology, scientists demonstrated that DHEA levels were significantly lower in elderly persons predisposed to chronic wound conditions, such as venous ulcers, and that administration of DHEA accelerated wound healing in aging mice. This led the research team to suggest that DHEA supplementation may be a safe, effective strategy to improve wound healing in the elderly.16

Natural therapies may help to optimize DHEA levels. You may wish to discuss with your doctor the use of pregnenolone or DHEA. Those with estrogen-related cancers such as breast or prostate cancer should not use DHEA.

5. Prostate-Specific Antigen (PSA) (Men Only)

Prostate-specific antigen (PSA) is a protein manufactured by the prostate gland in men. Elevated levels may suggest an enlarged prostate, prostate inflammation, or prostate cancer. PSA levels may also be used to monitor the efficacy of therapeutic regimens for prostate conditions.

Elevated levels of PSA may not necessarily signal prostate cancer, and prostate cancer may not always be accompanied by expression of PSA. Levels can be elevated in the presence of a urinary tract infection or an inflamed prostate. A PSA level over 2.5 ng/mL, or a PSA doubling time (the time required for PSA value to double) of less than 12 years, may be a cause for concern.

The American Cancer Society recommends annual PSA testing for men beginning at age 50. Men who are at high risk should begin PSA testing at age 40-45. PSA levels increase with age, even in the absence of prostate abnormalities.17

More than 15% of men with PSA values between 2.6 and 4.0 ng/mL who are 40 years or older have prostate cancer, according to a prostate cancer screening study published in 2005 in the Journal of Urology.18

According to a study published in the Journal of the American Medical Association, 25% of patients with normal digital rectal exams and total PSA levels of 4.0-10.0 ng/mL have prostate cancer.19 In a later study published in the New England Journal of Medicine, investigators recommended that “lowering the threshold for biopsy from 4.1 to 2.6 ng per milliliter in men younger than 60 years would double the cancer-detection rate from 18 percent to 36 percent.”20 It should be noted that levels below the currently recognized cutoff of 4.1 ng/mL may not distinguish between prostate cancer and benign prostate disease.

OPTIMAL RANGE OF PROSTATE-SPECIFIC ANTIGEN (PSA)

Current Laboratory Reference Range

Optimal Range

0-4 ng/mL

0-2.6 ng/mL



In a recently published study in the journal Urology, prostate cancer was detected in 22% of patients with PSA levels between 2.0 and 4.0 ng/mL, and most of those cancers biopsied were significant, leading researchers to conclude that an “important number of cancers could be detected in the PSA rangeof 2.0 to 4.0 ng/mL.”21 In another study, investigators in Spain detected significant cancers in some patients with a PSA range between 1.0 and 2.99 ng/mL. Although the risk of developing cancer for those in the low PSA range is small, the authors said, it is still relevant.22

A healthy Mediterranean-type diet may offer protection against prostate cancer and other diseases associated with aging. Natural therapies may also help support prostate health. You and your physician may wish to discuss the use of saw palmetto, beta-sitosterol, pygeum, and nettle root extracts. (See also “Beta-Sitosterol and the Aging Prostate Gland,” Life Extension, June 2005.)

6. Homocysteine

The amino acid homocysteine is formed in the body during the metabolism of methionine. High homocysteine levels have been associated with increased risk of heart attack, bone fracture, and poor cognitive function.

Incremental increases in the level of homocysteine correlate with an increased risk for coronary artery disease. Data from the Physicians’ Health Study, which tracked 14,916 healthy male physicians with no previous history of heart disease, showed that highly elevated homocysteine levels were associated with a more than threefold increase in the risk of heart attack over a five-year period.23

Homocysteine has also become recognized as an independent risk factor for bone fractures. In a recent study of 1,267 men and women with an average age of 76, investigators in the Netherlands concluded that high homocysteine levels and low vitamin B12 concentrations were significantly associated with an increased risk for bone fracture.24 This mirrors data from two previous studies published in 2004 in the New England Journal of Medicine, in which elevated homocysteine levels were shown to be an important and independent risk factor for osteoporotic fractures, including hip fractures.25,26

OPTIMAL RANGE OF HOMOCYSTEINE

Current Laboratory Reference Range

Optimal Range

MALE
4.3-15.3 µmol/L

MALE
< 7.2 µmol/L

FEMALE
3.3-11.6 µmol/L

FEMALE
< 7.2 µmol/L



Elevated homocysteine levels have recently been linked to other disorders. In three recent studies, investigators found an association between elevated homocysteine levels and age-related macular degeneration.27-29 In Japan, increased homocysteine levels were found to be associated with the presence of gallstones in middle-aged men. Investigators suggested that this association “may partly explain the reported high prevalence rate of coronary heart disease” in persons with gallstones.30

A study from the Netherlands has shown that among normal individuals aged 30-80, elevated homocysteine concentrations are associated with prolonged lower cognitive performance.31

Natural therapies may help to optimize homocysteine levels. You may wish to discuss with your doctor the use of vitamin B12, vitamin B6, folic acid, and trimethylglycine.

Continued . . .


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