Q. Hello, Dr. Costrini. I am just 23 years of age but am generally concerned about my health. I do have high blood pressure and I have been searching the Internet for information about tests that I should have done on a regular basis. I know that women have tests done every several years and for age 20, and the number of tests increase as they get older. How about a man? All I can dig up on the Net are 40 to 50 years of age and above. I know I should have some tests but I cannot find any.

A. Thank you for your very interesting question Matt. Your question relates to probably the single most significant advance in health care in the past 100 years. For disorders that are very common what screening tests can be done in order to find them early or to prevent them entirely. Since the commonest causes of death and disease in the United States are heart disease, cancer, strokes, lung disease, injury, diabetes, pneumonia, Alzheimer's disease, and kidney disease, it is certainly reasonable as a generalization to screen patients for high blood pressure, elevated cholesterol, and other risk factors for heart disease. Similarly, screening patients for the common cancers such as cancer of the colon, cancer of the breast, lung cancer, cervical cancer, etc. is also appropriate. In your situation the significant causes of ill health and death are a bit different. The leading causes of death in patients 15 to 24 years of age are #1: Unintentional injuries (accidents, gunshot wounds, and falls), homicides principally by guns, and the third leading cause is suicides. From a purely statistical point of view, the most important thing a young person can do is to make life style changes to prevent unintentional injuries, to avoid circumstances where violence is common (drug trafficking, etc), and to be mindful of their own emotional health. In the unintentional injury category certainly auto accidents are #1. In this regard, wearing a seat belt and not drinking alcohol and driving is the single most important thing you can do to protect your health. With regard to emotional health, if you have had difficulty with interaction with your peers, family members or have episodes of severe sadness lasting several weeks, it is very important to get help from a physician. In your particular case you mention high blood pressure. Blood pressure should be checked at least every two years and if you smoke, have diabetes, or if heart disease runs in your family, you should begin to have a cholesterol and triglyceride blood tests beginning at age 20. Additionally if you have a family history of colon cancer and that family member had their colon cancer diagnosed below the age of 40, you should have a colon cancer check 10 years before the age of that family members diagnosis. Tests for diabetes should be carried out because you have a history of high blood pressure. In this regard, an important consideration for you would be a kidney blood test and urinalysis to further evaluate your high blood pressure. It is also recommended that in patients younger than age 40 with high blood pressure, high cholesterol, diabetes, or a smoking history that they should begin taking daily low dose aspirin. You should also be screened for communicable diseases if you are at risk perhaps in association with alternative life styles. With regard to life style, it is entirely appropriate for you to seriously consider discontinuation of smoking if you smoke at the present time, reduce your body weight to an ideal body weight with a program of exercise and to limit alcohol to no more than one to two drinks per day. Screening tests have become particularly important in the younger age group because it is clear that while heart disease is the leading cause of death, most patients who have heart attacks have had risk factors for many years. Smoking, obesity, high blood pressure beginning in the second, third, and fourth decade of life are probably the causes of the death by heart disease or stroke, and in some cases cancers, that occur later in life and appear as overall statistics. Screening is designed not only to find disease but also to find risk factors for disease. So blood tests to check your cholesterol, triglycerides, blood sugar, and evidence of sexually transmitted diseases would be the most appropriate screening tests in your age group. Blood pressure checks and changes in life style as discussed above would be the second important issues that you should consider in order to protect your health. Thank you for your very interesting question.

Dr. Costrinis column appears every other week in the Savannah Morning News. Questions can be addressed to the website ncostrini@georgiagi.com