How Do Blood Tests Fit Into the Comprehensive Exam?
We began a blog series to define the components of the standard-six comprehensive preventive exam at Cooper Clinic with, ‘What Does a Comprehensive Exam Entail?.’ In this post, we introduced the series and covered the first of six components, Medical Exam & Counseling. Our second component of six is Laboratory Analysis.
Component #2: Laboratory Analysis
Comprehensive lab testing includes cholesterol profile, blood sugar level, complete blood count, homocysteine, urinalysis, high sensitivity C-reactive protein, thyroid stimulating hormone, vitamin D, omega-3 and other important tests. Cooper Clinic’s in-house lab provides same-day results for our physicians to review with the patients. Depending if the patient is new or returning, we examine up to 70 blood tests.
There are a number of risk factors for the development of chronic disease that can only be identified by blood tests. You certainly would not want to find out that you have high cholesterol by having a heart attack!
A complete cholesterol panel is an important test for prevention. Knowing the numbers in your cholesterol profile (total cholesterol, HDL (good) cholesterol, LDL (bad cholesterol) and triglycerides) helps define your risk for heart disease and stroke.
Almost 32 million adults have significantly high cholesterol levels (≥240 mg/dL). More than one of four adults has high triglyceride levels (risk factor for heart disease and stroke). An HDL cholesterol level <40 mg/dL in adult males and <50 mg/dL in adult females is considered low and is a risk factor for heart disease and stroke; about half of all adults have an HDL cholesterol < 52 mg/dL. What side of 52 mg/dL median level is your HDL? Given that in more than a third of patients, the very first sign of heart disease is death, this is definitely a chronic disease you want to prevent.
Fasting Blood Sugar
A fasting blood sugar measurement and a hemoglobin A1C measurement (which estimates your average blood sugar over the last three months) are important tests for prevention. An estimated 20 million American adults have been diagnosed with diabetes (fasting glucose ≥ 126 mg/dL). Another eight million adults have full blown diabetes, but don’t know it. More than 87 million adults (38 percent of the population) have prediabetes (fasting blood glucose 100-125 mg/dL). If you have prediabetes, you can take active steps in improving lifestyle to significantly lower your risk of developing full blown diabetes. Given that the presence of diabetes can result in vision loss, kidney dysfunction, heart attacks, strokes, poor circulation and amputations, this is definitely a chronic disease you want to prevent.
Kidney disease is another chronic condition that is detected by changes in blood work long before symptoms occur. More than 26 million adults (13 percent of the population) have chronic kidney disease and many do not even know it. Another 20 million are at risk for developing kidney disease because they have risk factors for kidney disease like diabetes or high blood pressure. Chronic kidney disease is a risk factor of heart disease and stroke.
The sooner you know if your kidney blood tests are abnormal, the sooner you can take proactive steps to protect your kidneys from further damage. Given that chronic kidney disease may require treatment with dialysis or kidney transplantation, this is another chronic disease you can prevent.
Vitamin D is a fat-soluble vitamin that has helps keep calcium and phosphate levels in the blood normal which is important for healthy bones. Although more research is needed in these areas, preliminary studies have demonstrated that vitamin D deficiency is associated with increased risk of death from all causes, cardiovascular events including sudden cardiac death and stroke, diabetes, hypertension and impaired function of the immune and musculoskeletal system.
If you visit clinicaltrials.gov, where all on-going clinical trials are listed, and search vitamin D, you will see that vitamin D deficiency and vitamin D supplementation is being studied in countless conditions including preventing diabetes, improving periodontal (gum disease), reducing hot flashes and improving fatigue! It is clearly the “it” vitamin of this decade.
Vitamin D is made in the skin in the presence of sun exposure. We can also get vitamin D from natural sources like fatty fish (less commonly) and more commonly from fortified foods (milk, breads and cereals). Despite the fact that sun exposure is not hard to come by and that fortified foods are generally available, vitamin D deficiency is shockingly common. A recent national survey of American adults (NHANES survey) identified that 42 percent of adults were vitamin D deficient.
Identifying vitamin D deficiency is simple (with a single blood test) and improving vitamin D levels is easy too once you know you need to do it! Given the myriad of on-going clinical trials involving vitamin D, who knows how many chronic diseases vitamin D levels may influence.
To learn more about a preventive exam at Cooper Clinic, click here or call 866.906.2667 (COOP). Stay tuned for the third component within the exam, cardiovascular screening.