What preventive health maintenance plan should be recommended for a 45‑year‑old adult?

Health Maintenance at Age 45

At age 45, initiate colorectal cancer screening, assess cardiovascular risk with consideration for statin therapy if risk factors are present, ensure blood pressure and lipid screening are current, update vaccinations, and counsel on lifestyle modifications including diet, exercise, and smoking cessation. 1

Colorectal Cancer Screening

• Begin colorectal cancer screening now at age 45 with either high-sensitivity stool-based testing (FIT annually) or structural examination (colonoscopy every 10 years, flexible sigmoidoscopy every 5-10 years, or CT colonography every 5 years). 1
• The American Cancer Society updated their recommendation in 2018 to begin screening at age 45 for average-risk adults, which represents a shift from the traditional age 50 threshold. 1
• The USPSTF followed suit in 2021, now recommending screening starting at age 45 years. 1
• Choose colonoscopy if patient prefers a single comprehensive exam every 10 years; choose annual FIT if patient prefers non-invasive testing. 1

Cardiovascular Risk Assessment and Management

Risk Factor Screening

• Measure blood pressure at this visit and document smoking status, diet, physical activity level, and family history of premature cardiovascular disease. 1
• Obtain fasting lipid panel (total cholesterol, LDL-C, HDL-C, triglycerides) and fasting glucose. 1
• Calculate body mass index and waist circumference. 1

Statin Therapy Consideration

• Calculate 10-year ASCVD risk using the Pooled Cohort Equations if patient has ≥1 cardiovascular risk factor (dyslipidemia, diabetes, hypertension, or smoking). 1, 2
• Initiate moderate-to-high intensity statin therapy if 10-year ASCVD risk is ≥7.5% AND patient has ≥1 risk factor. 1
• For 10-year risk ≥10%, this is a Grade B recommendation (moderate certainty of net benefit). 1
• For 10-year risk 7.5-10%, this is a Grade C recommendation (small net benefit; offer selectively based on individual circumstances). 1
• If LDL-C ≥160 mg/dL with hypertension or other risk factors, initiate statin therapy regardless of calculated risk score. 2

Blood Pressure Management

• Target blood pressure <130/80 mmHg if hypertension is present. 2
• Initiate or optimize antihypertensive therapy if blood pressure is elevated, with thiazide diuretics as part of the regimen for most patients. 2

Prostate Cancer Screening (Men Only)

• For men aged 45 at average risk: engage in shared decision-making about PSA screening, discussing potential benefits (possible mortality reduction) versus harms (overdiagnosis, unnecessary biopsies, treatment complications). 1
• For African-American men or men with first-degree relative diagnosed with prostate cancer before age 65: strongly consider offering PSA screening starting at age 45. 1
• The evidence remains controversial, with the USPSTF (2018) recommending individualized decision-making for men 55-69 years, but several organizations including the American Cancer Society recommend earlier discussions for high-risk groups. 1

Breast Cancer Screening (Women Only)

• Women should begin discussing mammography screening, though routine screening typically begins at age 50 according to most guidelines. 3
• Individual risk factors (family history, genetic predisposition) may warrant earlier initiation—assess these factors now. 3

Diabetes Screening

• Screen for diabetes with fasting glucose or HbA1c if patient has hypertension, obesity (BMI ≥25 kg/m²), family history of diabetes, or sedentary lifestyle. 1, 2
• Repeat screening every 2-3 years if risk factors are present. 1

Immunizations

• Ensure influenza vaccine is administered annually. 4, 5
• Verify tetanus-diphtheria-pertussis (Tdap) booster is current (every 10 years). 5
• Assess need for other vaccines based on risk factors: hepatitis B (if risk factors present), HPV (if not previously vaccinated and age-appropriate), zoster vaccine (typically age 50+). 5

Lifestyle Counseling

Diet

• Recommend Mediterranean-style diet: emphasize fruits, vegetables, whole grains, legumes, fish, lean protein, and low-fat dairy products. 2
• Limit saturated fat to <7% of total calories, cholesterol to <200 mg/day, and eliminate trans fats. 2

Physical Activity

• Prescribe at least 150 minutes of moderate-intensity aerobic activity per week (30 minutes most days), plus resistance training 2 days per week. 1, 2

Weight Management

• Target BMI 18.5-24.9 kg/m² and waist circumference <40 inches (men) or <35 inches (women). 2
• If overweight/obese, recommend 5-7% weight loss through combined dietary modification and increased physical activity. 1

Tobacco Cessation

• If patient smokes, provide intensive counseling and offer pharmacotherapy (varenicline, bupropion, or nicotine replacement). 1
• Smoking cessation provides immediate and long-term cardiovascular and cancer risk reduction. 1

Additional Screening Considerations

• Screen for depression and alcohol misuse using validated tools. 3
• Assess fall risk if any mobility concerns or history of falls (though this becomes more critical after age 65). 1
• Ensure dental care is current with annual dental visits. 6

Common Pitfalls to Avoid

• Do not delay statin therapy while attempting lifestyle modifications alone if patient meets criteria—initiate both simultaneously. 2
• Do not use LDL-C level in isolation to determine statin eligibility; use global risk assessment. 1, 2
• Do not screen for prostate cancer without first engaging in shared decision-making about benefits and harms. 1
• Do not assume all preventive services can wait until age 50—colorectal cancer screening now begins at 45. 1