What are the recommended screenings and assessments for a male patient during a wellness visit, considering age-related risks and potential health conditions such as hypertension (high blood pressure), hyperlipidemia (elevated lipid profile), and diabetes?

Adult Male Wellness Visit: Recommended Screenings and Assessments

For an adult male wellness visit, prioritize cardiovascular disease prevention through blood pressure measurement, lipid screening (starting at age 40), diabetes screening in those with hypertension or hyperlipidemia, colorectal cancer screening (starting at age 45), and tobacco use assessment, with screening intervals and additional tests determined by age and specific risk factors. 1, 2

Cardiovascular Health Screenings

Blood Pressure

• Measure blood pressure at every wellness visit, as hypertension is a critical modifiable risk factor for cardiovascular mortality 3
• Screen all adults with sustained blood pressure >135/80 mm Hg for diabetes, as this combination significantly increases cardiovascular event risk 4

Lipid Screening

• Begin lipid screening at age 40 for all men, measuring total cholesterol and HDL cholesterol (non-fasting samples acceptable) 1, 5
• Screen men ages 40-75 years at 5-year intervals if results are normal; more frequently if borderline 1, 5
• For men 20-35 years, screen only if risk factors present (diabetes, family history of premature CVD, hypertension, smoking) 5
• Confirm all abnormal lipid results with repeat testing before diagnosis 1
• Calculate 10-year cardiovascular disease risk using validated risk calculators incorporating age, diabetes status, cholesterol levels, blood pressure, and smoking status 2
• Initiate low- to moderate-dose statin if 10-year CVD risk ≥10% AND patient has ≥1 CVD risk factor 2

Diabetes Screening

Screen for type 2 diabetes in all adults with hypertension or hyperlipidemia, as detecting diabetes in these patients substantially improves cardiovascular risk stratification and reduces cardiovascular events and mortality. 4

Risk-Based Approach

• Screen all adults with BMI ≥25 kg/m² who have additional risk factors: physical inactivity, hypertension, HDL <35 mg/dL or triglycerides >250 mg/dL, history of cardiovascular disease, A1C ≥5.7%, first-degree relative with diabetes, high-risk ethnic group membership 4
• For adults without risk factors, begin screening at age 45 4
• Rescreen every 3 years if initial results are normal 4, 2

Testing Method

• Use fasting plasma glucose (FPG ≥126 mg/dL) as the preferred screening test, as it is easier to perform, more convenient, less expensive, and more reproducible than 2-hour post-load glucose testing 4
• Confirm diagnosis with repeat FPG on a separate day, especially for borderline results 4

Critical Caveat

The evidence for routine diabetes screening in normotensive, normolipidemic adults remains insufficient, as no studies demonstrate that early treatment from screening provides incremental benefit over treatment after clinical diagnosis 4. However, screening is strongly justified when hypertension or hyperlipidemia coexist because lowering blood pressure to <80 mm Hg diastolic in diabetic patients with hypertension reduces cardiovascular events and mortality 4.

Obesity Assessment

• Calculate BMI at every visit 2, 3
• If BMI ≥30 kg/m², offer or refer to intensive, multicomponent behavioral interventions 2
• If prediabetes identified, refer to intensive behavioral counseling combining diet and physical activity with multiple contacts over extended periods 2

Cancer Screenings

Colorectal Cancer

• Begin screening at age 45 with one of the following options: annual high-sensitivity FOBT or FIT, flexible sigmoidoscopy every 5 years, colonoscopy every 10 years, CT colonography every 5 years, multitarget stool DNA test every 3 years 1, 3
• Do not delay screening beyond age 45, as guidelines have recently lowered the recommended starting age from 50 1
• Follow up all positive non-colonoscopy screening tests with timely colonoscopy 1

Prostate Cancer

• For average-risk men, do NOT routinely screen with PSA testing before age 55 2
• For men ages 55-69, use shared decision-making to discuss potential benefits versus harms of PSA screening 1, 3
• For African American men or those with strong family history of prostate cancer, consider individualized shared decision-making about earlier screening starting at age 45 1, 2

Lung Cancer

• Screen men ages 55-80 with at least 30-pack-year smoking history who currently smoke or quit within past 15 years using low-dose CT 3

Abdominal Aortic Aneurysm

• Perform one-time screening ultrasonography in men ages 65-75 who have ever smoked 3

Tobacco and Alcohol Use

• Ask about tobacco use at every visit and provide cessation interventions if patient uses tobacco products 2, 3
• Assess alcohol use patterns and provide counseling as needed 3

Immunizations

• Update all immunizations according to Advisory Committee on Immunization Practices guidelines, including tetanus-diphtheria 3, 6

Aspirin for Primary Prevention

• Do NOT routinely recommend aspirin for primary prevention in men under age 79 2
• Consider aspirin only in men ages 45-79 when benefit of myocardial infarction reduction exceeds gastrointestinal bleeding risk 2

Common Pitfalls to Avoid

• Failing to screen for diabetes in patients with hypertension or hyperlipidemia, where screening has proven cardiovascular mortality benefit 4
• Not confirming abnormal lipid or glucose results before making a diagnosis 1
• Overlooking the importance of shared decision-making for prostate cancer screening rather than routine PSA testing 1
• Screening very high-risk patients (age ≥65, BMI ≥35, hypertension) occurs at high rates (>80%), but younger obese patients (ages 35-44, BMI 30-35) are frequently under-screened despite meeting screening criteria 7