When to Start Laboratory Testing in Annual Routine Physical Exams
Begin lipid screening (total cholesterol and HDL) at age 35 for men and age 45 for women if no risk factors are present; start earlier at age 20 if diabetes, family history of early cardiovascular disease, familial hyperlipidemia, or multiple cardiac risk factors exist 1.
Age-Based Screening Initiation
Lipid Screening
The most clearly defined laboratory testing in routine physicals involves cardiovascular risk assessment:
Men aged 20-35 and women aged 20-45: Screen only if risk factors present, including:
- Diabetes
- Family history of cardiovascular disease before age 50 (male relatives) or age 60 (female relatives)
- Family history suggesting familial hyperlipidemia
- Multiple coronary heart disease risk factors (tobacco use, hypertension) 1
All men ≥35 years and all women ≥45 years: Begin routine lipid screening regardless of risk factors 1
Screening Intervals
Repeat lipid screening every 5 years for average-risk individuals, with shorter intervals for those with borderline values and longer intervals for low-risk persons with repeatedly normal results 1.
What to Measure
- Total cholesterol and HDL can be measured on non-fasting samples and are the recommended screening tests 1
- Total cholesterol alone is acceptable if reliable HDL measurement is unavailable 1
- LDL and triglycerides require fasting samples and are more expensive; reserve these for patients with elevated screening results to guide treatment decisions 1
Blood Pressure Screening
While not strictly "blood work," blood pressure measurement should begin at age 25 for men and age 40 for women based on prevalence data 2.
Tests NOT Recommended Routinely
Research suggests against routine use of:
Common Pitfalls
- Ordering comprehensive metabolic panels reflexively without considering individual risk
- Screening too early in truly low-risk individuals wastes resources
- Failing to confirm abnormal results with repeat testing before initiating treatment 1
- Ordering fasting lipid panels when non-fasting total cholesterol and HDL suffice for initial screening
Special Considerations
After age 65, repeated screening becomes less important as lipid levels stabilize, though initial screening may be appropriate for those never previously screened 1. Treatment decisions should always incorporate overall cardiovascular risk assessment rather than lipid levels in isolation.