As a healthy 40‑year‑old cardiologist with no symptoms, which baseline laboratory tests should I have?

Baseline Laboratory Testing for a Healthy 40-Year-Old Cardiologist

As a healthy 40-year-old cardiologist, you should obtain a comprehensive metabolic panel, fasting lipid profile (total cholesterol, LDL-C, HDL-C, triglycerides), fasting glucose, thyroid-stimulating hormone, complete blood count, urinalysis, and a 12-lead ECG. 1, 2

Core Laboratory Panel

Your baseline evaluation should include the following tests:

• Comprehensive metabolic panel including serum electrolytes (sodium, potassium, calcium, magnesium), blood urea nitrogen, serum creatinine with estimated glomerular filtration rate calculation 1
• Fasting lipid profile with total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides 1
• Fasting plasma glucose to screen for diabetes (normal <5.6 mmol/L or 100 mg/dL; impaired fasting glucose 5.6-6.9 mmol/L or 102-125 mg/dL; diabetes ≥7.0 mmol/L or 126 mg/dL) 1
• Thyroid-stimulating hormone (TSH) 1
• Complete blood count 1
• Urinalysis 1

Cardiovascular Risk Assessment

At age 40, you should undergo cardiovascular risk stratification:

• Calculate your 10-year ASCVD risk using the Pooled Cohort Equation, which incorporates age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure, diabetes status, and smoking status 1
• Measure waist circumference as central obesity (>102 cm in men, >88 cm in women) is an independent cardiovascular risk factor 1
• Obtain a resting 12-lead ECG as recommended for all patients being evaluated for cardiovascular risk, particularly to establish a baseline and screen for left ventricular hypertrophy or conduction abnormalities 1, 2, 3

Risk Factor Identification

Screen for the following cardiovascular risk factors, as their presence determines treatment thresholds:

• Hypertension: Blood pressure ≥130/80 mmHg (or ≥140/90 mmHg by older definitions) 1
• Dyslipidemia: Total cholesterol >5.0 mmol/L (190 mg/dL), LDL-C >3.0 mmol/L (115 mg/dL), HDL-C <1.0 mmol/L (40 mg/dL) in men or <1.2 mmol/L (46 mg/dL) in women, or triglycerides >1.7 mmol/L (150 mg/dL) 1
• Impaired fasting glucose or diabetes: Fasting glucose 5.6-6.9 mmol/L (102-125 mg/dL) or ≥7.0 mmol/L (126 mg/dL) 1
• Family history: Premature cardiovascular disease in first-degree relatives (men <55 years, women <65 years) 1

Additional Considerations for Physicians

Research shows that physicians, including cardiologists, have significantly lower cardiovascular risk factor burden compared to the general population, with lower rates of hypertension (16.9% vs 29.6%), diabetes (5.0% vs 11.3%), and smoking (13.1% vs 21.6%) 4. However, physicians paradoxically undergo less preventive screening than the general population (periodic health examinations 58.9% vs 67.9%, lipid screening 76.3% vs 83.8%) 4.

Common pitfall: Despite being healthcare providers, physicians often have inflated self-perception of low cardiovascular risk even when objective risk factors are present 5. Do not assume your medical knowledge translates to optimal personal health practices—obtain objective measurements rather than relying on self-assessment.

Tests NOT Recommended

The following tests are not recommended for routine screening in asymptomatic, low-risk individuals:

• Coronary calcium scoring or coronary CTA is not indicated for cardiovascular risk stratification in low-risk asymptomatic adults 1
• Exercise stress testing is not recommended routinely in asymptomatic individuals without major risk factors, as it has poor positive predictive value in low-risk populations 1
• Routine circulating biomarkers (such as hs-CRP, BNP, or troponin) are not recommended for cardiovascular risk stratification in asymptomatic individuals 1
• Carotid ultrasound intima-media thickness is not recommended for cardiovascular risk assessment 1

When to Consider Exercise Testing

Exercise ECG testing should be considered if you have moderate-to-high cardiovascular risk, defined as age >40-45 years with ≥1 of the following risk factors: hypercholesterolemia (total cholesterol >200 mg/dL, LDL >130 mg/dL, or HDL <35 mg/dL in men/<45 mg/dL in women), hypertension (≥140/90 mmHg), current smoking, diabetes, or family history of premature cardiovascular disease in first-degree relatives <60 years old 1. However, at age 40 with no symptoms and assuming you lack multiple risk factors, routine exercise testing is not indicated.

Frequency of Reassessment

• Lipid profile: Repeat every 4-6 years if normal, more frequently if borderline or if lifestyle modifications are implemented 1
• Fasting glucose: Repeat every 3 years if normal, annually if impaired fasting glucose 1
• Blood pressure: Check at every healthcare visit, at minimum annually 1
• ECG: Repeat periodically (every 2-5 years) to detect interval changes, particularly if risk factors develop 1, 2