What specific tests should a Black man over 40 have that most annual physicals don't order?

Six tests that belong on every Black man's cardiovascular panel over 40 that a standard annual physical does not routinely include: (1) Lp(a), measure once, genetically determined, approximately twice as likely to be elevated in African ancestry; (2) ApoB, the actual particle count that drives atherogenesis, more predictive than LDL-C, available at any direct-to-consumer lab for $30–50; (3) hs-CRP, systemic inflammation marker that predicts cardiovascular events independently of cholesterol; (4) fasting insulin, detects insulin resistance years before HbA1c rises, identifies the upstream driver of metabolic cardiovascular risk; (5) home blood pressure series, both arms, morning and evening for two weeks, averages more meaningful than a single office reading; and (6) coronary artery calcium score (CAC) at age 40–45 if there is family history of premature cardiovascular disease or any of the above markers are elevated.

These six tests add approximately $200–400 in out-of-pocket cost to a standard annual physical panel and provide the complete cardiovascular picture that fourteen-minute primary care appointments systematically do not. The man who walks out of his annual physical with a "clean bill of health" derived from total cholesterol, LDL, glucose, and a single office blood pressure reading has not had a cardiovascular risk assessment. He has had a screening. These six tests are the difference. (AHA/ACC Prevention Guidelines, 2019 update)

Cardiologist's calibrated position, Solid (1) for each of these six tests as clinically indicated in Black men over 40 with any cardiovascular risk factors.

What to do: Order Lp(a), ApoB, hs-CRP, and fasting insulin through LabCorp Patient or Quest Direct at your next opportunity. These do not require a physician's order in most states.

For the full picture, read The Cardiac Inheritance.