Blood work after 40: which tests do you really need?

Blood work after 40: no panel fits everyone. What US guidelines recommend, the usual core tests, add-ons by risk profile, and how often to retest.

Blood work after 40: which tests do you really need?

7 min - BioSense Team - 2026-06-24

  • level:essential
  • bilan sanguin
  • prévention
  • 40 ans
  • examens

There is no universal annual blood test after 40. Useful blood work depends on your age, history and risk factors. A common core combines a lipid panel, fasting glucose or A1C, a complete blood count, kidney function and liver function, with TSH depending on context. This article reviews what US guidelines actually recommend, which tests to discuss with your doctor, and why more tests do not always mean better care.

You book your yearly physical with your primary care doctor. You leave with a lab order, get your blood drawn, and see the results in your patient portal. But you are not quite sure what was ordered, or why some tests are included and others are not. You may also wonder whether you should have "more" tests, like the ones promoted everywhere online.

Here is how to think about useful blood work from age 40: what US guidelines say, what usually makes up the core, what is worth adding based on your profile, and what to ask.

How often should you get blood work after 40?

No major US guideline calls for a full annual blood panel for every adult. The US Preventive Services Task Force (USPSTF) makes recommendations test by test, for defined groups. Some of them directly concern blood work after 40:

  • Prediabetes and type 2 diabetes (grade B, 2021): screening for adults aged 35 to 70 who have overweight or obesity. The best interval is uncertain; every 3 years may be reasonable when results are normal.
  • Hepatitis C (grade B, 2020): screening for adults aged 18 to 79.
  • HIV (grade A, 2019): screening for people aged 15 to 65, and older adults at increased risk.
  • Statins for prevention (grade B, 2022): adults aged 40 to 75 with at least one cardiovascular risk factor and a 10-year risk of 10% or more. Estimating that risk requires a cholesterol result.

For cholesterol itself, the 2026 ACC/AHA dyslipidemia guideline is summarized as advising a lipid check at least every 5 years in adults, more often when risk is higher or treatment is underway.

The idea of a yearly check for everyone has also been questioned. The Society of General Internal Medicine, in the Choosing Wisely campaign, revised its advice in 2023: check-ups and routine lab work should be guided by age, risk factors and needs rather than by habit. People with overdue preventive care or lower self-rated health, those who rarely see a primary care doctor, and adults aged 65 or older may benefit most from a yearly visit.

So the useful interval varies after 40, and it is usually shorter with cardiovascular or metabolic risk factors. A healthy adult with no medical history can often space blood work out more than someone on long-term medication or with a strong family history.

A different approach in the UK

The UK takes a more scheduled route. The NHS Health Check invites adults aged 40 to 74 without certain existing conditions every 5 years, with a cholesterol test and possibly a blood sugar test.

Key point - No US guideline recommends one universal yearly blood panel after 40. The USPSTF recommends specific tests for specific groups, and the useful rhythm depends on your profile.

Routine blood tests often ordered after 40

Six families of tests make up a common panel after 40. Not all of them are recommended for everyone, so ask why each one is on your order.

1. Lipid panel: total cholesterol, LDL, HDL, triglycerides

The cornerstone of cardiovascular prevention. LDL cholesterol is the main marker of atherogenic risk. The 2026 ACC/AHA guideline restored LDL goals that depend on risk: below 100 mg/dL (2.6 mmol/L) at borderline or intermediate risk, and below 70 mg/dL (1.8 mmol/L) at high risk. That is why the same number needs a contextual reading. The same guideline calls for measuring lipoprotein(a) at least once in adulthood.

2. Fasting glucose or A1C

The usual tests for diabetes and prediabetes. In the US, the American Diabetes Association (ADA) places prediabetes at a fasting glucose of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) or an A1C of 5.7% to 6.4% (39 to 46 mmol/mol). Diabetes starts at 126 mg/dL (7.0 mmol/L) or an A1C of 6.5% (48 mmol/mol), generally confirmed by a second test. A1C reflects average blood sugar over about three months.

3. Complete blood count (CBC)

A routine test measuring red cells, white cells and platelets. It can point to anemia, infection, inflammation or rarer abnormalities. Your doctor may add a CRP or sedimentation rate when there is a clinical reason.

4. Kidney function: creatinine and eGFR

Blood creatinine is used to calculate an estimated glomerular filtration rate (eGFR), which reflects how well your kidneys filter. It is particularly useful with high blood pressure, diabetes, or regular use of certain medications such as NSAIDs. It is often included in a basic or comprehensive metabolic panel.

5. Liver function: ALT, AST (and GGT depending on context)

ALT and AST are liver enzymes. They can rise with fatty liver disease (now often called MASLD), heavy alcohol use, or as a side effect of certain medications. They are also part of a comprehensive metabolic panel.

6. TSH (thyroid)

The first-line test of thyroid function, especially useful with symptoms such as fatigue, weight change, feeling cold or palpitations. For adults without symptoms, the USPSTF (2015) found the evidence insufficient to recommend for or against screening (I statement). Discuss it with your doctor rather than assuming it is needed.

Key point - Lipid panel, glucose or A1C, CBC, kidney function, liver function and, depending on context, TSH make up the usual core. Each has its own reason for being there.

Tests to discuss based on your risk profile

Beyond the core, some tests are worth discussing depending on your situation. These are add-ons with a reason, not tests to order by default.

Iron status: ferritin and transferrin saturation

Particularly relevant with heavy periods, a vegetarian or vegan diet, endurance sports or persistent fatigue. Ferritin reflects your iron stores, and transferrin saturation shows how much iron is circulating.

Vitamins: D and B12

For vitamin D, routine testing is not recommended for healthy adults. The USPSTF (2021) found the evidence insufficient to recommend for or against screening adults without symptoms, and the Endocrine Society (2024) suggests against routine testing. Testing still has a place when a doctor suspects a deficiency or a bone or absorption problem.

Vitamin B12 is worth discussing with persistent fatigue, numbness or tingling, a strict vegan diet, older age, or long-term use of metformin or acid-reducing medications (proton pump inhibitors).

A1C

If your order includes only fasting glucose, ask whether A1C adds anything. It is often considered with excess weight, a family history of diabetes, borderline fasting glucose or high blood pressure.

PSA, uric acid, CRP, calcium: targeted markers

Other tests may fit specific situations. PSA is an individual decision for men aged 55 to 69 under the USPSTF (grade C, 2018), and the USPSTF recommends against PSA screening from age 70 (grade D). The American Cancer Society suggests starting the conversation at 50, or earlier with higher risk. Uric acid may be checked with joint pain or a history of gout, CRP when inflammation is suspected, and calcium with bone disorders.

Key point - Ferritin, vitamins D and B12, A1C, PSA, uric acid and CRP depend on your profile and risk factors. The conversation with your doctor is what makes them useful.

Why more blood tests isn't always better

Direct-to-consumer panels often promise dozens of markers. It is tempting to think that more data means better prevention, but each extra test has a cost that does not show up on the price tag.

The main reason is statistical. Reference ranges leave out about 5% of healthy people for each test, and a 2025 review in the Journal of the American Board of Family Medicine calculates that about 64% of healthy people will have at least one flagged result on a panel of 20 tests. Each flag can lead to worry, repeat tests and further investigations, sometimes for nothing.

Vitamin D is the classic example. Testing became very common without evidence that screening healthy adults improves health, which is why the American Society for Clinical Pathology listed population-wide vitamin D screening among the practices to question in the Choosing Wisely campaign.

A targeted, well-interpreted panel is more useful than an exhaustive one read out of context. The right question is not "how many markers?" but "what will this result change for me?".

The BioSense method

A blood test is only valuable in context. BioSense cross-references your results with your health questionnaire, age, sex, history, current treatments, lifestyle, reason for the test, any symptoms. Your results are also tracked over time, which makes it possible to spot a drift early.

*ChatGPT answers you. BioSense knows you.* *BioSense, your prevention companion.* BioSense does not provide a diagnosis and does not replace your doctor. It is a prevention companion that helps you understand, ask the right questions and act day to day.

Blood work after 40: three questions to ask your doctor

Before your next appointment, here are three questions to guide the lab order:

  • Given my history, my age and my risk factors, which blood tests are genuinely useful this year?
  • How often should I repeat these tests?
  • Which preventive screenings am I due for, and what would each result change for me?

This preparation saves time during the visit and steers the conversation toward what really matters for you.

Frequently asked questions

Should you get blood work every year after 40?

Not necessarily. No major US guideline recommends a full annual panel for all adults. The useful interval depends on the test, and it is usually shorter with risk factors or chronic conditions. Your doctor adapts the rhythm to your situation.

What blood tests should you get after 40?

The usual core is a lipid panel, fasting glucose or A1C, a complete blood count, creatinine with eGFR, ALT and AST and, depending on context, TSH. Ferritin, vitamins or PSA are discussed according to your profile.

Does the USPSTF recommend annual blood work?

No. The USPSTF rates specific screenings for specific groups, such as diabetes screening in adults aged 35 to 70 with overweight or obesity (grade B) and hepatitis C screening in adults aged 18 to 79 (grade B).

Should healthy adults get a vitamin D blood test?

Not routinely. The USPSTF found the evidence insufficient for screening adults without symptoms, and the Endocrine Society suggests against routine testing. Your doctor may test when there is a specific reason.

Import your blood test into BioSense and receive a plain-language explanation of each of your biomarkers, placed in the context of your profile, with tracking over time. Your data is hosted on servers located in France.

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Sources and methodology

United States

United Kingdom

*BioSense methodology: our content is based on guidance from US authorities and medical societies (such as the USPSTF, CDC, NIH, FDA, ACC/AHA and ADA), UK bodies (NICE, NHS), European societies and the WHO. Sources are listed by country, and differences between countries are stated when they matter.*

Going further

*This article is for informational purposes only and is neither medical advice nor a diagnosis. For any questions about your health, consult your doctor.*