Many people have routine blood tests done at least once yearly at their annual preventive health exam or with their PCP. These tests typically include screenings for anemia, diabetes, electrolyte imbalances, liver disorders, kidney disorders, and abnormal cholesterol. Many of these tests are also used when determining a diagnosis for bothersome symptoms or illness. Sometimes these tests do not reveal all of the answers as to the cause for symptoms, or they may not give a complete picture about the risk for chronic illness. The five tests described below are often overlooked in traditional medical practices. Yet they are tests that can add significant detail and value to information about illnesses or risk for chronic disease, and for this reason are important to know about.

Are You At Risk for Diabetes?

Most adults have their blood glucose (blood sugar) checked periodically as a screening test for diabetes.  There are two common ways to do this. A fasting blood glucose test checks the blood glucose level at a single moment in time. A hemoglobin A1c (HA1c) test reflects the average blood glucose level over the previous 12 weeks.  These two tests provide good information about the potential for prediabetes (increased risk for diabetes) or actual diabetes.     

There is another important medical test, however, that is often overlooked. It provides even more information about how the body metabolizes blood glucose. This is the fasting insulin test.  The pancreas makes insulin whose purpose is to process “sugar” from food. This process creates energy for the body.  Insulin is present when there is blood glucose to process following ingestion of food.  An elevated fasting insulin is abnormal. It can indicate insulin resistance and possibly diabetes.  Insulin resistance can also indicate increased risk of heart disease, cancer, Alzheimer’s disease, and PCOS. The fasting insulin test has the potential to provide an earlier diagnosis or a warning about the possibility of these conditions.

Vitamin B12 – An Often Overlooked Cause of Fatigue, Memory Problems, and Neuropathy

Vitamin B12 is such an important nutrient and acts as a cofactor for many body processes. It is one of the most frequently overlooked medical tests, however. B12 is one of many B vitamins responsible for the health of the blood and nerve cells in the body.  It also helps make DNA.  If B12 is low, fatigue, memory problems, mood problems, heart problems, and neuropathy can occur.  Low B12 can contribute to certain types of anemia, macular degeneration, dementia, and osteoporosis. Risk factors for B12 deficiency include vegan diet, gastrointestinal problems (such as IBS, dysbiosis, or leaky gut), taking proton pump inhibitors such as omeprazole (Prilosec), taking metformin, and older adults.   A simple blood test can determine vitamin B12 levels. And low B12 levels are often easy to correct.

Got Iron?

Adequate iron is important in the body for maintaining healthy blood cell production and preventing anemia. There are several ways to measure for iron deficiency in the body. Most adults have this done through a routine complete blood count (CBC). This test reveals hemoglobin levels which reflects the number of oxygen carrying red blood cells circulating in the body. Another test for anemia is the serum iron test, and it checks for iron levels in the blood at a single moment in time. Food consumed just prior to the test will influence the test results. Therefore, it does not give a complete picture of how the body is doing overall in terms of producing and storing iron. 

The most accurate and most sensitive, but often overlooked medical test for detecting early iron deficiency is the ferritin test. Serum iron can be normal even when a serum ferritin is abnormal. This would not be revealed unless both were checked. Therefore, the ferritin test helps to provide a more complete picture of iron in the body.

Cholesterol Testing and Heart Disease Risk

Most adults have their cholesterol checked periodically to determine if there is a higher risk for heart disease. In the typical cholesterol tests, information is provided about lipids (fats) in the body. The most common cholesterol tests reflect information about individual types of lipids and sometimes lipid ratios such as the following.

Lipids

• LDL-C (low density lipoprotein) is the form of cholesterol that can deposit in plaques (“bad cholesterol”) and is the primary target of cholesterol-lowering therapy. 
• HDL-C (high density lipoprotein) (“good cholesterol”) promotes reverse cholesterol transport. It carries LDL cholesterol away from the arteries and back to the liver. The liver then excretes the bad cholesterol as bile.
• Triglycerides (TG) are the most common type of fat in the body and store excess energy from the diet. Triglycerides are a well-established marker of CVD risk. 
• Total Cholesterol (TC) includes LDL, VLDL, and HDL cholesterol and levels correlates with atherosclerotic CVD.

Lipid Ratios

• Lipid Ratios: Multiple studies have shown that lipoprotein ratios have a greater correlation with CVD and are better predictors than individual lipid measurements.
• TC/HDL Ratio predicts the formation of coronary plaques and coronary heart disease; the higher the ratio, the greater the risk for developing atherosclerosis. 
• TG/HDL Ratio predicts both metabolic and cardiovascular risk. It is also associated with insulin resistance.

Apolipoproteins

Most of us do not typically get measurements of apolipoproteins which are important components of cholesterol. Although often overlooked or not included, these medical tests can reveal important risk information.

• Apo A-1 is the main component of HDL and assists in reverse cholesterol transport (HDL is “good cholesterol”). 
• Apo B is the main component of atherogenic lipoprotein particles, i.e. LDL, Lp(a), and others (LDL is “bad cholesterol”); Apo B is a stronger indicator of atherogenicity than LDL-C alone. 
• Apo B/Apo A-1 Ratio has a higher predictive ability for metabolic syndrome, CVD, obesity, insulin resistance, diabetes, MI, and early atherosclerosis as compared to standard lipid evaluations. 
• Lp(a) is a lipoprotein that is genetically determined. It causes damage via inflammation and oxidative stress. 

Cardiometabolic Markers

There are two important biomarkers that can significantly add to the overall picture of risk for cardiovascular disease. They are often not included in routine evaluation of cardiovascular risk, however.

• hsCRP (C Reactive Protein) is an inflammatory marker that can help identify the risk level for CVD in healthy people.

• Homocysteine is toxic to the lining of the blood vessels contributing to damage and atherosclerosis 

There are many labs now that offer more extensive cardiovascular risk biomarkers such as those described above. Adults who are considered to be at higher risk of cardiovascular disease or whose risk is unclear should request a more extensive evaluation that includes the above components.

Still Not Sure About Your Cardiovascular Risk?

Risk for cardiovascular disease can be questionable at times, despite monitoring cholesterol levels and other risk factors. Many adults have abnormal cholesterol. Medical providers often recommend prescription medication in these cases. Some adults are hesitant to take cholesterol medication if they do not have symptoms or other risk factors. Others may present with normal cholesterol levels but have a high family history and thus concern for risk based on that. In these cases it is often helpful to consider another often overlooked medical test that can provide additional information about CVD risk.

The Coronary Artery CT Calcium Scan determines whether coronary artery disease (CAD) is present. It details the extent of the problem, even if there are no symptoms.  A higher score suggests a higher chance of significant narrowing in the coronary arteries and a higher risk of future heart attack.  This is a good test to consider if there is higher risk (I.e. high cholesterol, family history of heart disease, history of smoking in the past or present, overweight, inactive lifestyle) and there are no symptoms.  The test is similar to an xray. Insurance generally does not pay for this test, and the cost is typically in the range of about $140.

Don’t Forget to Ask

We all want to have a true and accurate picture of our health and our disease risk. The above , often forgotten, medical tests are certainly worth considering in many cases. Don’t hesitate to ask your provider or PCP about these tests. They may appreciate the opportunity to discuss them and will surely give you their insight as to whether you might benefit from the additional information that can be provided about your health and risk.

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