Cholesterol
, check. Metabolic panel, check. Two thumbs up from your doctor, check, check. Based on the results of your blood and urine tests at your
annual physical
, you conclude your body is a well-oiled machine. But this picture of health may be incomplete. The need for efficiency in medicine can sometimes
limit
the tests you get by default, and additional metrics could help flag early signs of
chronic diseases
when they’re most treatable.
There’s a balance between a one-size-fits-all approach to annual lab tests and ordering
labs for every potential marker
under the sun. Experts think certain non-routine tests are worth asking your doctor about, since the results could point to health-saving interventions.
A1C and 1-hour glucose
More than
115 million Americans
have prediabetes——the stage right before developing prediabetes—yet
less than 20% know it
. Blood tests can identify prediabetes, but many doctors “aren’t ordering them because they don’t think the patient is at risk,” says Dr. Tracey McLaughlin, professor of endocrinology at Stanford University.
Prediabetes
causes no obvious symptoms; people often feel fine even as their blood sugar drifts into a risky range. Doctors typically tailor their screening practices to
risk factors
like age (35 or older), obesity, and family history, but people can develop prediabetes even without these indicators, McLaughlin says.
The main blood tests you can request—if your doctor doesn’t order them—include hemoglobin A1C and fasting glucose. A1C reflects average blood sugar over the past 2-3 months. Fasting glucose captures how well the body is controlling blood sugar at one point in time.
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Another important one to discuss with your doctor is the oral glucose tolerance test, or the OGTT, where you consume a sugary drink to see how quickly your blood sugar rises in two hours. (The lab-run version
is better than trying this at home
with a continuous glucose monitor.)
A 1-hour version of this test, though rarely ordered at annual physicals,
may reveal prediabetes,
even when A1C, fasting glucose, and the 2-hour OGTT are normal. When researchers studied people with issues like high blood pressure and waist circumference, but without prediabetes, the ones with fast-rising glucose at one hour were
much more likely
to develop prediabetes in 7.5 years than those with slower-rising glucose.
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Based on the results of these tests, you can take steps to avoid prediabetes or diabetes.
Physical activity and dietary changes
, resulting in lower body weight, cut
diabetes risk by 58%
, according to a landmark trial. Other research links these behaviors to people being able to stave off diabetes for up to
20 years
, and they can be
combined with GLP-1 drugs
.
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“Interventions make the most difference the earlier the issue is discovered,” McLaughlin says. People in higher risk groups should have these screening tests every year. If you don’t have elevated risk and your test results are normal,
every three years
is fine, according to the
U.S. Preventive Services Task Force
.
Lp(a)
Nearly
half of adults
in the U.S. have cardiovascular disease. Lipoprotein(a), or
Lp(a)
, is a
cholesterol-carrying
particle that, when elevated, puts people at more risk. The good news is that testing for Lp(a) is usually covered by insurance—and you typically only have to do it once. The bad news is that
only 1%
of Americans have actually had it measured, since doctors
don’t typically include it
at checkups.
This may be changing. In March, the American Heart Association issued
guidelines
that officially endorsed Lp(a) measurement in adults for the first time. “It’s a big shift,” since doctors will start testing Lp(a) at physicals, says Dr. Michelle O’Donoghue, a cardiologist at Brigham and Women’s Hospital and associate professor at Harvard Medical School.
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Lp(a) particles contribute to heart disease because they have a tail that carries fats prone to getting stuck in artery walls, leading to inflammation and plaque buildup.
Unlike glucose markers, Lp(a) is mostly genetic; numbers run high in certain families and don’t change much over a lifetime. People of Black and South Asian descent tend to have
higher levels
. Worldwide,
20-30% of people
have elevated Lp(a).
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Though Lp(a) is basically fixed, it should be checked at least once in every adult’s lifetime, O’Donoghue says, since learning about it can prompt action to address other aspects of heart disease risk that are modifiable. Examples include eating a healthier diet and taking a cholesterol-lowering therapy, such as a statin drug. “A 30-year-old with very elevated Lp(a) might be at risk,” O’Donoghue says. “In that case, we would be more aggressive about addressing their modifiable risk factors.”
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New therapies to lower Lp(a) are
being studied
in humans, with results expected later this year. “These drugs are not far off on the horizon,” O’Donoghue says.
C-reactive protein
High-sensitivity C-reactive protein, or
hs-CRP
, is a molecule linked to inflammation spreading in the body, though it doesn’t pinpoint the source of the fire. The liver ramps up production of this hs-CRP molecule when the body is under attack or injured, such as when people have undiagnosed cardiovascular issues, infections, or
autoimmune diseases
like rheumatoid arthritis.
hs-CRP binds to damaged cells and microbes, making it easier for the immune system to recognize them. “It’s sort of a global barometer of inflammation, and inflammation is the key driver of atherosclerosis, or plaque buildup, in our arteries,” O’Donoghue says.
If tests show that hs-CRP and Lp(a) are both elevated, that suggests a bigger problem than only one high marker, O’Donoghue says. Even so, hs-CRP is not necessarily part of standard testing. It represents a gray zone, as some
guidelines
say more evidence is needed to recommend for or against doctors testing it. Other guidance treats hs-CRP as a
risk-enhancing factor
that could aid decisions about how aggressively to intervene to prevent disease, O’Donoghue explains.
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Consider a 48-year-old with slightly elevated
LDL cholesterol
and blood pressure, and a father who died of a heart attack at 58. Measuring hs-CRP could be one more factor to help determine which preventive steps to take, O’Donoghue says.
Measures of this protein can be interpreted alongside exam findings to uncover
other problems
before symptoms occur. However, there’s also the risk of sounding a false alarm. More trivial issues, like a bad bruise, can
cause
hs-CRP to rise, so it’s important to avoid jumping to conclusions.
Urine albumin-to-creatinine ratio
The urine albumin-to-creatinine ratio, or
UACR
, is another test to consider. Albumin is a protein made by the liver that carries hormones and balances body fluids. UACR measures how much albumin is leaking from the bloodstream into urine, and then compares it with levels of creatinine, a waste product. If the resulting ratio is high, you may have excess albumin in your urine. This condition, called
albuminuria
, is an early sign of kidney disease.
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Kidney disease affects about
35 million Americans
, and
nearly 90%
aren’t aware they have it. It’s
a leading cause of death
worldwide.
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Although doctors almost always measure creatinine at checkups, UACR is “rarely tested,” says Dr. Morgan Grams, a nephrologist and professor of medicine at NYU Grossman School of Medicine. UACR is
recommended
for anyone who’s 65 or older, or has high blood pressure, diabetes, obesity, or known kidney disease. But
it’s checked
in only about 35% of people with diabetes and 4% of those with hypertension, Grams’ research shows
“It’s a missed opportunity,” Grams says; if UACR catches albuminuria early, it’s “100% actionable.” Newly available
treatments
protect the kidneys from the disease—and potentially reverse albuminuria, Grams says.
Fibrosis-4
It’s also worth asking about fibrosis-4, or
FIB-4
, which is a score based on your age, levels of liver enzymes called AST and ALT, and a count of blood-clotting cell fragments called platelets.
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FIB-4 plays an
important role
in diagnosing liver fibrosis, or scarring of the liver. That matters because people can develop fatty liver disease and other types of liver damage
without obvious symptoms
. “Doctors are starting to use FIB-4 for earlier identification,” McLaughlin says.
People with obesity or diabetes should ask their doctors about FIB-4, since their risk for liver disease is
higher
. “The underlying biomarkers aren’t necessarily actionable, but when you combine them into the FIB-4 risk score, that does determine action,” Grams says. If FIB-4 raises a red flag, the next step is a
noninvasive imaging test
to inspect the liver.
Being in charge of your health doesn’t mean insisting on every test, but asking about the right ones could help catch problems early.