What lab tests are recommended for annual health screenings in adults?

Recommended Annual Laboratory Tests for Adults

For most adults, annual health screenings should include blood pressure measurement, diabetes screening (A1C or fasting glucose), lipid profile, and targeted testing based on individual risk factors.

Core Laboratory Tests for All Adults

• Blood Pressure Measurement - Should be performed at every visit, with annual screening recommended for all adults. More frequent screening (every 3-5 years) is recommended for adults aged 18-39 years with no risk factors, and annual screening for those at increased risk (African American, high normal blood pressure, obesity, or age >40 years) 1

• Diabetes Screening:

  • For adults aged 35 years and older, regardless of risk factors 1
  • For adults of any age with overweight or obesity (BMI ≥25 kg/m² or ≥23 kg/m² in Asian Americans) who have one or more risk factors (family history, high-risk race/ethnicity, history of cardiovascular disease, hypertension, low HDL, high triglycerides, polycystic ovary syndrome, physical inactivity) 1
  • Screening options include fasting plasma glucose, 2-hour plasma glucose during 75-g oral glucose tolerance test, or A1C 1
  • If results are normal, repeat testing at minimum 3-year intervals 1

• Lipid Profile - For adults with low-risk lipid values (LDL <100 mg/dl, HDL >50 mg/dl, and triglycerides <150 mg/dl), repeat lipid assessments every 2 years; otherwise, test annually 1

  • Nonfasting samples are acceptable for cardiovascular risk prediction 2

Age-Specific Recommendations

• Adults 35-65 years:

  • Core laboratory tests as listed above 1
  • Blood pressure screening annually if at increased risk, otherwise every 3-5 years 1

• Adults over 65 years:

  • Comprehensive metabolic panel (CMP) - assesses kidney and liver function, electrolyte balance 3
  • Complete blood count (CBC) with differential - screens for anemia, infection, blood disorders 3
  • Thyroid-stimulating hormone (TSH) - thyroid disorders increase with age 3
  • Urinalysis with albumin-to-creatinine ratio - screens for kidney disease 3

Risk-Based Additional Testing

• Diabetes Management (for those with diagnosed diabetes):

  • A1C test at least twice yearly if meeting treatment goals, quarterly if therapy has changed or not meeting goals 3
  • Annual screening for chronic kidney disease with urinary albumin and serum creatinine testing 1

• Cardiovascular Risk Assessment:

  • For patients with clinical CVD and LDL >100 mg/dl, pharmacological therapy should be initiated 1
  • Consider aspirin therapy (75-162 mg/day) as secondary prevention in those with history of cardiovascular events 1

• Men's Health:

  • Prostate-Specific Antigen (PSA) testing should be offered annually beginning at age 50 to men with life expectancy of at least 10 years (or age 45 for high-risk men, including African American men and those with first-degree relatives diagnosed at young age) 1, 3

Special Considerations

• Medication-Related Monitoring:

  • Vitamin B12 levels should be checked annually in patients taking metformin 3
  • Serum potassium levels should be monitored in patients taking ACE inhibitors, ARBs, or diuretics 3
  • Consider screening for prediabetes or diabetes if on certain medications such as glucocorticoids, statins, thiazide diuretics, or some HIV medications 1

• Geriatric Patients:

  • Annual screening for cognitive impairment is indicated for adults 65 years of age or older 1
  • More individualized glycemic goals based on functional status, with A1C targets ranging from <7.5% for healthy older adults to 8.0-8.5% for those with multiple chronic illnesses or functional dependence 3

Cost-Effectiveness Considerations

• Using targeted screening approaches rather than universal testing can be more cost-effective 4
• Basic metabolic panel (BMP) instead of comprehensive metabolic panel (CMP) may be appropriate for patients without specific risk factors, potentially reducing costs 5