Earlier than most people expect for the basics, and later for imaging. Blood pressure checks belong in every adult's routine from age 18. Cholesterol and overall risk assessment start in early adulthood. Scans such as a coronary calcium score are usually a question for your 40s and beyond, and only when the result would change a decision.
The right timing also depends on you. A strong family history, diabetes or very high cholesterol moves everything earlier.
Key takeaways
- Blood pressure checks start at 18, and cholesterol and risk assessment begin in early adulthood.
- Lp(a) is usually measured once in adulthood, and you generally have to ask for it.
- A calcium score is mainly a question for ages 40 to 75 with borderline or intermediate risk, when the result would change a decision.
- For a healthy young adult a scan is likely to be zero, tells you little and still involves a small radiation dose.
- A strong family history, diabetes or very high cholesterol moves the timing earlier, and symptoms need medical evaluation, not screening.
The basic checks and when they start
These are the building blocks of heart screening. They are simple, low cost and well supported by evidence.
| Check | When it starts | Notes |
|---|---|---|
| Blood pressure | Age 18 | High readings in the office should be confirmed with readings outside the clinic. |
| Cholesterol and risk assessment | From age 20, with a 10-year risk estimate from about 40 | In younger adults the focus is on lifetime risk and habits. |
| Blood sugar | Age 35 to 70 if you have overweight or obesity | Earlier if your clinician sees other reasons to test. |
| Lp(a) | Once in adulthood | An inherited level that stays fairly stable, so one test is usually enough. |
Blood pressure. The US Preventive Services Task Force recommends screening for high blood pressure in all adults 18 and older, and confirming a high office reading with measurements taken outside the clinic before treatment starts.1
Cholesterol. US cholesterol guidance treats age 20 as the start of adult risk assessment. For adults aged 20 to 39, the 2018 cholesterol guideline puts the priority on estimating lifetime risk and building healthy habits, and uses a 10-year risk estimate to guide decisions from age 40 to 75.2 The current calculator, PREVENT, can be used from age 30.
Blood sugar. The US Preventive Services Task Force recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 who have overweight or obesity.3 Blood sugar problems often develop quietly for years, so this check matters even when you feel well.
Lp(a). Lipoprotein(a) is a cholesterol particle whose level is set mostly by your genes. The 2026 ACC/AHA cholesterol guideline advises measuring Lp(a) once in all adults.4 It is not part of a standard cholesterol panel, so you usually have to ask for it. Our Lp(a) test guide explains what a high result means.
How often to repeat these checks depends on your results and your risk. Ask your clinician what interval fits you.
When a calcium score is worth considering
A coronary artery calcium (CAC) score is a CT scan that measures calcified plaque in the heart's arteries. It is not a routine test for everyone.
It is most useful in a specific situation: you are roughly 40 to 75, you have no symptoms, your calculated risk is borderline or intermediate, and you and your clinician are unsure whether to start medication. In the 2018 cholesterol guideline, a calcium score is an option for adults aged 40 to 75 at intermediate risk when the decision about a statin is uncertain. A score of zero can support waiting. A higher score supports treatment.
There are honest limits to state here. The US Preventive Services Task Force concluded that the evidence is insufficient to judge the benefits and harms of adding a calcium score to standard risk assessment in adults without symptoms.5 Guidelines from heart specialists support its selective use. Both positions agree that it is not a test for everyone.
Why scans are not for low-risk young adults
If you are 30 and healthy, a calcium score is likely to be zero. Calcium appears late in the life of a plaque, so a zero at a young age tells you little and cannot rule out soft plaque.
The scan also uses radiation. A professional society guideline on calcium scanning says the effective dose should average 1.0 to 1.5 mSv.6 That is a small dose, but there is no reason to accept it for a result that will not change your care.
For younger adults the useful information comes from blood pressure, cholesterol, blood sugar, Lp(a) and family history. These show the forces that build plaque long before a scan can see it.
Who should start early
Some people should not wait for the usual ages. Talk to your clinician about earlier and more thorough assessment if any of these apply:
- Family history of early heart disease. This means a father or brother affected before 55, or a mother or sister before 65. See what a family history means for you.
- Diabetes. Diabetes raises heart risk and can blunt warning symptoms.
- Very high LDL cholesterol or familial hypercholesterolemia. An LDL of 190 mg/dL or higher is treated as a high-risk category in its own right. If a close relative has familial hypercholesterolemia, ask about testing.
- Early menopause. Menopause before age 40 is listed as a risk enhancer, as is a history of preeclampsia.
- Chronic inflammatory conditions. Rheumatoid arthritis, psoriasis and chronic HIV are named in the guideline.
- Chronic kidney disease. Kidney and heart health are closely linked.
Starting early does not mean having every test. It means getting the basics done sooner and deciding with your clinician whether anything else would add real information.
Screening is not for symptoms
Everything above applies to people who feel well. If you have chest discomfort, breathlessness with effort, fainting or palpitations, that is not a screening question. It needs prompt medical evaluation, and sudden or severe symptoms mean calling 911.
Your next step: check which tests fit your situation
If you are deciding what to ask for, read our guide to the coronary calcium score, which covers who the scan may help and what it cannot tell you.
You can also answer the three quick questions in the Cardio Res-Q screener on our program page to see whether a closer evaluation makes sense for you.
Are You a Candidate for Cardio Res-Q?
Three quick questions about the risk factors we screen for. Your answers stay between you and the clinic.
Frequently asked questions
I am in my 30s with no risk factors. What do I need?
The basics: a blood pressure check, a cholesterol panel if you have not had one, and a one-time Lp(a) test. Knowing your family history matters as much as any lab result. Imaging is generally not useful at this age unless you have a specific high-risk condition.
Should I get a calcium score at 40?
Only if it would change a decision. It is most helpful for adults at borderline or intermediate risk who are unsure about starting medication. If your risk is clearly low, or already clearly high, the scan is unlikely to change the plan.
My father had a heart attack at 50. When should I start?
Now, whatever your age as an adult. A first-degree male relative affected before 55 counts as premature family history. Have your blood pressure, cholesterol, blood sugar and Lp(a) checked, and ask your clinician whether further testing makes sense for you.
Is a stress test a good screening test?
Not for people without symptoms. The US Preventive Services Task Force recommends against screening low-risk adults with a resting or exercise ECG. Stress testing is mainly used to evaluate symptoms.
Related reading
This article is for general education and is not medical advice. Decisions about testing and medication should be made with your clinician. If you have chest pain or other symptoms of a heart attack, call 911.
