Laboratory Screening for Cardiovascular Disease in Elderly Patients

Core Laboratory Tests

The European Society of Cardiology recommends that all elderly patients undergo a comprehensive lipid panel, fasting glucose, complete metabolic panel including serum creatinine with eGFR calculation, electrolytes, urinalysis with microalbuminuria assessment, and electrocardiogram as the core screening battery for cardiovascular disease 1, 2, 3
A fasting lipid profile including total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides should be performed, with target thresholds of 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, and triglycerides >1.7 mmol/L (150 mg/dL) 1, 2
Fasting plasma glucose should be measured to screen for diabetes (≥7.0 mmol/L or 126 mg/dL) or impaired fasting glucose (5.6-6.9 mmol/L or 102-125 mg/dL) 1, 5, 3
Serum creatinine with estimated glomerular filtration rate (eGFR) using the MDRD formula should be calculated, with a critical threshold of eGFR <60 mL/min/1.73 m² indicating chronic kidney disease and significantly elevated cardiovascular risk 1, 6, 5, 3

A 12-lead ECG should be part of routine assessment in all elderly patients with cardiovascular risk factors, looking for left ventricular hypertrophy using Sokolow-Lyon criteria (>38 mm) or Cornell voltage-duration product (>2440 mm·ms) 1, 6, 5, 3
Echocardiogram is recommended when ECG shows abnormalities, in uncontrolled hypertension, or when cardiac hypertrophy is suspected but not detected by routine tests 1, 6, 3

Ankle-brachial index (ABI) should be measured, with <0.9 indicating peripheral artery disease and approximately doubling 10-year cardiovascular mortality risk 1, 6, 5, 8
Carotid intima-media thickness (CIMT) should be measured, with >0.9 mm or presence of plaque indicating subclinical atherosclerosis 1, 6, 5, 8

High-sensitivity C-reactive protein (hs-CRP) should be measured for additional risk stratification in intermediate-risk patients 8
Serum uric acid should be measured as an inexpensive marker of increased cardiovascular risk 8, 3

Annual blood pressure assessment should be performed at minimum every 2 years 4
Lipid profiles should be performed every 5 years in patients without risk factors, and every 2 years in high-risk individuals 4
Electrolyte monitoring should be performed within 1-2 weeks of starting thiazides, with dose changes, and at least yearly 7
Renal function and potassium should be monitored closely in elderly patients on ACE inhibitors combined with thiazides 7