Preventive Care for a 27-Year-Old with No Risk Factors
For a healthy 27-year-old with no cardiovascular risk factors and a normal examination, routine laboratory screening is not recommended, and the focus should be on blood pressure measurement and selective behavioral counseling about diet and physical activity if the patient expresses interest. 1
Laboratory Testing
No routine bloodwork is indicated at age 27 without risk factors. Lipid screening should not begin until age 40 in the absence of cardiovascular disease risk factors such as diabetes, family history of premature CVD, tobacco use, hypertension, or obesity. 1
Blood pressure measurement should be performed at this visit, as it is universally recommended for adults. 2
Behavioral Counseling
The decision to offer behavioral counseling about diet and physical activity should be individualized based on patient interest and readiness to change. 3
The USPSTF gives a "C" recommendation for behavioral counseling in adults without obesity, hypertension, dyslipidemia, abnormal glucose, or diabetes—meaning the benefit is small but positive. 3
Patients who are interested and ready to make behavioral changes are most likely to benefit from counseling interventions. 3
If counseling is pursued, medium-intensity interventions (such as 2-3 face-to-face sessions with follow-up support) show better outcomes than low-intensity interventions, though higher-intensity interventions demonstrate the greatest benefit through a dose-response effect. 3
Harms of behavioral counseling are small to none, with no serious adverse events reported in trials. 3
Exercise Guidance
This patient can begin or continue moderate-intensity exercise (such as walking) without any formal medical screening or stress testing. 3
For men under 45 years and women under 55 years who are asymptomatic without known cardiovascular disease, cardiovascular workup is not needed before starting exercise unless there are extenuating circumstances like family history of sudden death at young age. 3
Requiring medical evaluation and stress testing before walking or equivalent moderate exercise in healthy young adults has not been proven useful and may serve as a barrier to healthful exercise. 3
The patient should be advised to seek medical attention if experiencing chest pain, dyspnea, joint pain, or lightheadedness with exercise. 3
Common Pitfalls to Avoid
Do not order routine lipid panels, metabolic panels, or other screening labs in healthy young adults without risk factors—this leads to unnecessary testing, false-positive results, and increased costs without proven benefit. 1
Avoid intensive behavioral counseling in patients who are not interested or ready to change—the small benefit of counseling is most likely to be realized in motivated individuals. 3
Do not require stress testing before moderate-intensity exercise in this low-risk population—this creates unnecessary barriers to physical activity. 3