At What Age Should Adults Start Getting Yearly Blood Work?
For healthy adults without risk factors, routine screening blood work should begin at age 35-45 years, with diabetes and lipid screening starting at age 35 for all adults and age 40 for cardiovascular risk assessment, respectively. 1, 2
Age-Based Screening Initiation
Starting at Age 35
- Diabetes screening should begin at age 35 for all adults, regardless of risk factors, using fasting plasma glucose, 2-hour plasma glucose during oral glucose tolerance test, or A1C 1
- For adults under 35 with overweight/obesity (BMI ≥25 kg/m² or ≥23 kg/m² in Asian Americans) plus additional risk factors (physical inactivity, family history, high-risk ethnicity, hypertension, abnormal lipids, PCOS, or cardiovascular disease history), screening should start earlier 3
Starting at Age 40-45
- Lipid screening (total cholesterol, HDL, LDL, triglycerides) should begin at age 40 for all adults 1, 2
- For those without specific risk factors for diabetes, screening can reasonably begin at age 45 3, 2
- Blood pressure measurement should occur at every healthcare visit starting in early adulthood, with formal annual screening by age 40 1
Screening Intervals After Initiation
For Normal Results
- Repeat diabetes screening every 3 years if initial tests are normal 3, 1
- Repeat lipid screening every 5 years for those with normal values 1, 2
- Blood pressure should be checked annually, or more frequently if readings are high-normal or risk factors are present 1
For Abnormal or High-Risk Results
- Annual diabetes screening for those with prediabetes (A1C 5.7-6.4%) 3
- Annual lipid screening for those with high-risk values 1
- More frequent intervals (shorter than 5 years) for lipid levels close to treatment thresholds 2
Risk Factors Warranting Earlier Screening (Age 20+)
The following conditions justify starting lipid and metabolic screening at age 20 rather than waiting until 35-40: 2
- Diabetes or prediabetes
- Family history of cardiovascular disease before age 50 in male relatives or age 60 in female relatives
- Multiple coronary heart disease risk factors (tobacco use, hypertension)
- Obesity
Core Annual Laboratory Panel Components
Once screening begins, a comprehensive annual panel should include: 1, 4
- Metabolic assessment: Comprehensive metabolic panel (kidney function, liver function, electrolytes, glucose)
- Diabetes screening: Hemoglobin A1C or fasting glucose
- Cardiovascular risk: Lipid profile (total cholesterol, HDL, LDL, triglycerides)
- Blood count: Complete blood count with differential
- Renal function: Urinalysis with albumin-to-creatinine ratio (especially for those with diabetes or hypertension)
Special Considerations for Older Adults (65+)
For geriatric patients, annual screening becomes more comprehensive: 4
- Add thyroid-stimulating hormone to annual testing (thyroid disorders increase with age)
- Include cognitive impairment screening annually
- For those with diabetes, A1C testing should occur at least every 6 months if meeting goals, more frequently if not 4
- Target A1C goals become more individualized (7.5-8% for most older adults, 8-9% for those with multiple comorbidities) 4
Important Practical Points
Confirmation of Abnormal Results
- Always confirm abnormal lipid results with a repeat sample on a separate occasion before making treatment decisions 2
- Use the average of both results for risk assessment 2
Fasting Requirements
- Total cholesterol and HDL can be measured on non-fasting samples 2
- Fasting samples are needed for accurate triglyceride and LDL measurements 2
Common Pitfalls to Avoid
- Do not rely on a single abnormal measurement for diagnosis or treatment decisions 2
- Avoid screening all young adults regardless of risk factors, which leads to unnecessary testing 2
- Do not wait until age 45 for patients with clear risk factors—screen earlier 3
- For patients on specific medications (ACE inhibitors, ARBs, diuretics, metformin), additional monitoring beyond routine annual labs is required 4