Recommended for both partners

• Blood pressure at least yearly. If elevated, confirm with home or ambulatory readings before labeling hypertension, as recommended by the USPSTF blood-pressure guidance.
• Height, weight, BMI and waist circumference.
• Cardiovascular risk review: smoking/vaping, diabetes risk, activity, diet, sleep apnea symptoms, and family history.
• Depression/anxiety and alcohol-use screening.
• Dental check-up every 6-12 months; eye examination periodically, sooner if vision symptoms, diabetes, hypertension, glaucoma risk, or contact lens use.
• Skin examination based on personal/family history and new or changing moles.

1. Lipid profile: total cholesterol, LDL-C, HDL-C, triglycerides.
   • Get a baseline now if not done recently.
   • Repeat interval depends on results and risk, commonly every 4-6 years when low risk, sooner if abnormal.
2. Diabetes screen: HbA1c or fasting plasma glucose.
   • At age 35, this is especially indicated if overweight/obesity. The USPSTF recommendation covers adults 35-70 with overweight or obesity.
3. HIV test at least once, and more often if exposure risk.
4. Hepatitis C antibody once for most adults; hepatitis B screening at least once or according to risk/pregnancy status.
5. STI tests only when indicated by sexual exposure, new/multiple partners, symptoms, pregnancy, or local clinician advice.

• Annual influenza vaccine.
• Updated COVID-19 vaccine as locally recommended.
• Tdap once in adulthood, then Td/Tdap booster every 10 years.
• Hepatitis B if not previously vaccinated or immune.
• HPV vaccination through age 26 routinely; ages 27-45 can be considered after discussion with a clinician.
• Other vaccines depend on travel, work, medical conditions, and prior records.

Male partner: additional priorities

1. TSH thyroid test
   • A baseline TSH is reasonable, particularly if the affected thyroid condition is in a first-degree relative, or if he has fatigue, weight change, constipation, palpitations, tremor, heat/cold intolerance, hair loss, neck swelling, or fertility concerns.
   • Add free T4 only if TSH is abnormal or symptoms suggest thyroid dysfunction.
   • Do not routinely order thyroid ultrasound or thyroid antibodies in an asymptomatic person with a normal examination and normal TSH. Ultrasound often finds harmless nodules and can lead to unnecessary follow-up.
2. Heart-risk assessment
   • Confirm whether the family history was premature cardiovascular disease: heart attack, stent, stroke, or sudden cardiac death before age 55 in a male first-degree relative or before age 65 in a female first-degree relative.
   • Lipid profile now, with closer follow-up if LDL is high or family history is premature.
   • Consider a one-time lipoprotein(a) [Lp(a)] test, especially with premature heart disease in the family. It is largely inherited and can refine risk assessment.
   • Consider ApoB if triglycerides are high, obesity/metabolic syndrome is present, diabetes is suspected, or cardiovascular risk is unclear.
3. Tests usually not needed just because of family history
   • Resting ECG
   • Exercise stress test
   • Echocardiogram
   • CT coronary calcium score
   These are not routine screening tests for an asymptomatic low-risk 35-year-old. A clinician may selectively use them if symptoms, markedly abnormal cholesterol, known inherited cardiac disease, or a strong premature family history changes the risk picture. Routine ECG-based screening has important limitations, reflected in Textbook of Family Medicine, 9e, “Limitations of Cardiovascular Screening.”

Female partner: additional priorities

1. Cervical cancer screening If she has a cervix and is age 30-65, choose one of:
   • Pap test every 3 years, or
   • High-risk HPV test every 5 years, or
   • HPV/Pap co-test every 5 years.
   This aligns with the USPSTF cervical-screening options.
2. Pregnancy and preconception care If pregnancy is possible or planned:
   • Review medications and vaccines.
   • Start folic acid 400-800 mcg daily before conception.
   • Check blood pressure, HbA1c/glucose as appropriate, STI status, immunity, and carrier screening according to ancestry/family history.
   • Thyroid testing is targeted if symptoms, thyroid history, autoimmune disease, infertility, recurrent miscarriage, or high-risk pregnancy factors are present.
3. Breast cancer screening
   • Routine mammography typically begins at 40 for average-risk women, every 2 years under current USPSTF guidance.
   • Start earlier or pursue genetic counseling only if there is significant breast/ovarian/pancreatic/prostate cancer history in the family, known BRCA-related mutation, prior chest radiation, or another high-risk condition.

Not routinely necessary at age 35 if healthy and asymptomatic

• CBC, kidney/liver panel, urinalysis, vitamin D, B12, iron/ferritin, testosterone, cortisol, or “hormone panels”
• Tumor markers such as CEA, CA-125, PSA
• Whole-body CT/MRI scans
• Thyroid ultrasound
• ECG, echo, treadmill stress tests
• Colonoscopy or stool colorectal screening before age 45 unless there is a high-risk family history or symptoms

Practical lab order list for this couple

• BP, BMI/waist measurement
• Lipid profile
• HbA1c or fasting glucose
• TSH
• One-time Lp(a), particularly if premature heart disease in a parent/sibling
• HIV, hepatitis B, hepatitis C testing if not previously completed or risk indicates

• BP, BMI/waist measurement
• Lipid profile
• HbA1c or fasting glucose if overweight/obesity or other risk factors
• Cervical screening if due
• HIV, hepatitis B, hepatitis C testing if not previously completed or risk indicates
• Pregnancy/preconception testing only if relevant