| Factor VIII
Factor VIII, which is also known as antihemophiliac
factor (AHF) or fibrin stabilizing factor, is a plasma coagulation
protein, and is a critical cofactor in the clotting process.
Data from clinical trials have shown that persons with high levels of factor
VIII are at increased risk of cardiovascular disease41 and recurrent venous
thromboembolism.42 Furthermore, high levels of factor VIII were determined
to be the cause, rather than a consequence, of venous thromboembolism.43
Other recent investigations support the hypothesis that there is a physiological
basis to the geriatric syndrome of frailty, which is characterized as a wasting
syndrome and physiological state of vulnerability to increased morbidity and
mortality. Data show a significant increase in markers of inflammation (factor
VIII, fibrinogen, and CRP) in the presence or absence of two prevalent chronic
diseases: diabetes and cardiovascular disease. Investigators surmise that these
specific physiological abnormalities “may make frail older adults more
vulnerable to disease processes, functional decline, and mortality.”44
BNP (brain natriuretic peptide)
BNP is released at continuously
low levels by the heart, though the rate of release may be increased
by various physiological and neuroendocrine factors that regulate
cardiac function. Increased levels of BNP have been associated
with hypertension, congestive heart failure (CHF),45 HIV-related
cardiomyopathy,46 and atherosclerosis, and is a powerful predictor
of left ventricular function and prognosis.47,48
Measurement of BNP involves a relatively simple, inexpensive blood test that
is able to diagnose CHF in 15 minutes. CHF is the fourth leading cause of hospitalization
in the U.S., and the leading cause of hospitalization among people over age
65. Its diagnosis is sometimes difficult, with symptoms such as shortness of
breath and edema (fluid retention) that are diagnostic of several conditions,
and physical examinations prone to error. Although markers such as cytokines
and catecholamines (stress hormones) are elevated in CHF, they are hard to
measure quickly and often are not elevated until the disease becomes severe.
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In a study of 250 patients with shortness of breath who were admitted to urgent
care and emergency rooms, BNP measurements of 80 pg/ml were 95% accurate in
diagnosing CHF, and lower values were 98% accurate in ruling out the condition.
Furthermore, urgent care physicians missed 30 cases of CHF diagnosed by the
cardiologists; a BNP test could have brought this figure down to one.49 One
of this study’s co-authors remarked that the test has greater diagnostic
accuracy than the PSA for prostate cancer, the mammogram for breast cancer,
or a PAP smear for cervical cancer. Given that one study estimated that up
to 20% of all CHF cases are misdiagnosed, the new test will enable urgent
care physicians to provide a more rapid, accurate diagnosis for this group
of patients.50
Millions of people worldwide with elevated blood glucose levels/Type II diabetes
are taking either Avandia™ or Actos™ (thiazolidinediones) to control
hyperglycemia. Patients with Type II diabetes are at increased risk of developing
or exacerbating CHF, and treatment with thiazolidinediones such as Avandia™ or
Actos™ further increases the risk.51,52
Until very recently, no way existed to identify those most likely to suffer
from this devastating side effect. In a recent study, however, data showed
that BNP levels were a good marker of left ventricular dysfunction (LVD)/CHF
induced by pioglitazone (actos). The investigators concluded that Type II diabetes
patients treated with pioglitazone (Actos™) who had elevated BNP levels
prior to the start of treatment should be carefully monitored using regular
BNP testing to avoid the adverse effects of CHF.53
Dietary
Selenium
The selenium test is used to monitor occupational exposure
to selenium and detect deficiencies in the serum.
An essential trace mineral, selenium is necessary for normal functioning of
the immune system and thyroid gland, and helps protect cells against free radicals
that can damage cells, contribute to chronic diseases, and promote cancers.
The amount of selenium contained in plant foods is determined by soil content
(e.g., high in the Dakotas, very low in some parts of China and Russia). Brazil
nuts, walnuts, and bread (in the U.S.) are high in selenium, as is meat from
animals that eat grains or plants grown in selenium-rich soils. The current
RDA is 55 mcg for men and women, 60 mcg for pregnant women, and 70 mcg for
women who are lactating. One ounce of brazil nuts supply 840 mcg of selenium.
Selenium deficiency, common in areas with selenium-deficient soil, may lead
to Keshan Disease (enlarged heart and poor heart function). Low levels are
also seen in patients on TPN (total parenteral nutrition) and patients with
malabsorption problems (severe gastrointestinal disorders). Deficiencies can
also affect thyroid function.
Studies indicated that the incidence of death from cancers (lung, colorectal
and prostate) is lower among people with higher blood levels of selenium.54-60 Furthermore, areas of the US with selenium-deficient soils have higher rates
of nonmelanoma skin cancer.61
Low levels of selenium may also be associated with an increased risk of heart
disease, rheumatoid arthritis, and HIV/AIDS.
Selenium levels should be tested in anyone who suspects occupational exposure
(toxic levels) and monitored in those living in areas of selenium-deficient
soil, as well as anyone with risk of (or who already has) heart disease, cancer,
or arthritis.
Vitamin B12 and Folate
Vitamin B12, found only in animal source
foods, is necessary for the formation and regeneration of red blood
cells. It also promotes growth and increases appetite in children,
increases energy, and helps maintain a healthy nervous system.
Elderly people suffering from neurological impairment find that
B12 supplementation improves their cognitive function.
Folic acid helps protect against chromosomal (genetic) damage; prevents atherosclerosis
caused by excess homocysteine; in high doses has been shown to decrease risk
of cardiovascular disease; is needed for the utilization of sugar and amino
acids; may prevent some types of cancer; promotes healthier skin; and helps
protect against intestinal parasites and food poisoning. It has also been established
that folic acid can prevent spina bifida; therefore, women of childbearing
age should increase their RDA of folic acid.
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