Blood Work for Cardiovascular Risk Assessment
All adults should have a fasting lipid profile (total cholesterol, LDL-C, HDL-C, triglycerides, non-HDL cholesterol), complete blood count with hemoglobin, serum creatinine with eGFR calculation, and glycemic assessment (HbA1c and/or fasting glucose) to assess cardiovascular risk. 1
Core Blood Tests Required
The following blood tests are recommended for all individuals to refine risk stratification, diagnose comorbidities, and guide treatment 1:
- Lipid profile including LDL-C - This is the cornerstone test and must include total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and non-HDL cholesterol 1, 2, 3
- Full blood count including hemoglobin - To identify anemia which impacts cardiovascular risk 1
- Serum creatinine with eGFR calculation - Essential because eGFR <60 mL/min/1.73 m² indicates chronic kidney disease and significantly elevated cardiovascular risk 1, 2, 3
- Glycemic status with HbA1c and/or fasting plasma glucose - To identify diabetes or prediabetes 1, 3
- Thyroid function - Should be assessed at least once in patients with suspected chronic coronary syndrome 1
Additional Recommended Testing
Urine albumin-creatinine ratio (UACR) should be measured instead of urine dipstick, as it is more sensitive for detecting early kidney disease and vascular endothelial damage 1, 2, 3. Microalbuminuria increases cardiovascular risk two- to four-fold, particularly in patients with diabetes or hypertension 2.
Age-Specific Screening Initiation
The timing of initial screening depends on risk factors 2, 3:
- High-risk patients (family history of premature CVD, diabetes, smoking, hypertension, or obesity): Begin comprehensive screening at age 20 2, 3
- Average-risk men: Begin at age 35 2, 3
- Average-risk women: Begin at age 45 2, 3
- All adults aged 40-75: Should undergo comprehensive lipid testing for cardiovascular risk assessment 2, 3
Screening Frequency
- Every 5 years for patients without risk factors 2, 3
- Every 2 years for patients with risk factors present or lipid levels close to treatment thresholds 2, 3
- Every 4-12 weeks after initiating lipid-lowering therapy to assess response 2, 3
Critical Implementation Points
Fasting samples are preferred for complete lipid assessment, though total cholesterol and HDL can be measured non-fasting if necessary 3. Abnormal results must be confirmed with a repeated sample on a separate occasion, using the average of both results for risk assessment 3.
Do not rely on urine dipstick alone for albuminuria screening - use UACR measurement instead, as dipstick is less sensitive and will miss early kidney disease 1. This is particularly important because chronic kidney disease is often overlooked despite being a powerful predictor of cardiovascular events 2.
Integration with Risk Calculation
These blood markers should be combined with age, sex, blood pressure measurements, smoking status, presence of diabetes, and family history to calculate 10-year ASCVD risk using the Pooled Cohort Equations 3, 4. Patients with ≥20% 10-year risk or diabetes are considered CHD risk equivalents requiring aggressive intervention 1, 3.
Common pitfall: 90% of patients with coronary heart disease have at least one atherosclerotic risk factor, making comprehensive screening essential rather than selective 2. Do not skip kidney function testing, as it is frequently overlooked despite its powerful predictive value 2.