When should cardiovascular risk screening begin in adults, including blood pressure measurement, smoking and lifestyle assessment, and lipid panel testing?

Cardiovascular Health Screening Guidelines

Begin cardiovascular risk screening at age 18 for blood pressure measurement, and at age 20 for comprehensive lipid and lifestyle assessment if risk factors are present, or at age 35 for men and age 45 for women without risk factors. 1, 2, 3

Blood Pressure Screening

Screen all adults starting at age 18 years for hypertension, as this prevents premature death, myocardial infarction, renal insufficiency, and stroke. 1, 4

• Measure blood pressure every 2 years if BP is <120/80 mm Hg 1
• Screen annually if systolic BP is 120-139 mm Hg or diastolic BP is 80-89 mm Hg 1
• Confirm hypertension diagnosis only after 2 or more elevated readings obtained on at least 2 visits over 1 to several weeks, due to measurement variability 1

Lipid Panel Screening

High-risk patients should begin comprehensive lipid screening at age 20 if any of the following are present: family history of premature cardiovascular disease, diabetes mellitus, current cigarette smoking, hypertension, or obesity. 2, 3

Average-risk men should begin lipid screening at age 35, while average-risk women should begin at age 45. 2, 3

• The fasting lipid profile is the cornerstone test and must include total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and non-HDL cholesterol 2, 3
• Repeat lipid profiles every 5 years in patients without risk factors 3
• Screen every 2 years if risk factors are present or lipid levels approach treatment thresholds 2, 3
• Abnormal results must be confirmed with a repeated sample on a separate occasion, using the average of both results for risk assessment 3

Glucose and Metabolic Screening

Begin fasting blood glucose screening at the same age and intervals as lipid screening (age 20 if risk factors present, otherwise age 35 for men and 45 for women, repeated every 5 years or every 2 years if risk factors present). 3

Start hemoglobin A1c screening at age 40-70 years in adults with BMI ≥25 kg/m², or at age 45 in those without risk factors. 1, 3

• Rescreening every 3 years may be reasonable for adults with normal blood glucose levels 1

Kidney Function Assessment

Measure serum creatinine with eGFR calculation as part of initial cardiovascular screening, as eGFR <60 mL/min/1.73 m² indicates chronic kidney disease and significantly elevated cardiovascular risk. 2, 3

Perform urinalysis with microalbuminuria assessment, particularly in patients with diabetes or hypertension, as microalbuminuria increases cardiovascular risk two- to four-fold. 2, 3

• Use urine albumin-creatinine ratio (UACR) rather than dipstick, as UACR is more sensitive for early kidney disease and vascular endothelial damage 3

Smoking and Lifestyle Assessment

Ask all adults about tobacco use starting at age 18 and provide tobacco cessation interventions to those who use tobacco products. 1

Assess lifestyle factors including physical activity, diet quality, alcohol intake, and body mass index as part of comprehensive cardiovascular risk evaluation. 1

• Consider the patient's overall cardiovascular risk profile, including smoking, diabetes, abnormal blood lipid values, age, sex, sedentary lifestyle, and obesity when making treatment decisions 1
• Nonpharmacologic interventions (dietary sodium reduction, potassium supplementation, increased physical activity, weight loss, stress management, and reduced alcohol intake) are associated with blood pressure reduction 1

Comprehensive Risk Assessment for Ages 40-75

All adults aged 40-75 should undergo comprehensive cardiovascular risk assessment combining blood markers with age, sex, blood pressure measurements, smoking status, presence of diabetes, and family history to calculate 10-year ASCVD risk. 2, 3

• Patients with ≥20% 10-year risk or diabetes are considered coronary heart disease risk equivalents requiring aggressive intervention 3

Common Pitfalls to Avoid

Do not ignore kidney function tests, as chronic kidney disease is a powerful predictor of cardiovascular events and is often overlooked. 2

Avoid delaying screening in young adults with risk factors—90% of patients with coronary heart disease have at least one atherosclerotic risk factor, making early comprehensive screening essential. 2

Do not rely on single blood pressure measurements for diagnosis due to variability; always confirm with multiple readings over separate visits. 1

Recent data show increasing prevalence of hypertension, diabetes, and obesity among young adults aged 20-44 years, particularly among Black and Hispanic populations, emphasizing the importance of early and equitable screening. 5