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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
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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.
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Deeb KK, Trump DL, Johnson CS. Vitamin D signalling pathways in cancer:
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potential for anticancer therapeutics. Nat Rev Cancer 2007;7(9):684–700.
Disease asscociations
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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.18,29-36
• 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