You go for Germany's Check-up 35, have blood drawn and are told that everything looks normal. That is reassuring. Later, you notice that the Check-up 35 blood tests cover glucose and cholesterol, but not HbA1c, insulin, ApoB, hs-CRP or TSH. This does not mean anything was overlooked. The statutory check-up simply answers a different question from a broader biomarker test.
Check-up 35 is a targeted preventive health assessment. It is designed to identify common health risks, connect a physical examination with your medical history and guide sensible next steps. It is not a complete laboratory dashboard, and it was never designed to be one.
Still, it helps to understand which blood tests are routinely included in Check-up 35, which additional markers offer a different perspective and when a personal baseline can be useful. Not to measure everything possible, but to define your question more precisely.
What Check-up 35 actually includes
People with statutory health insurance in Germany are generally entitled to this health assessment every three years from the age of 35. It does not begin with the laboratory. It begins with your medical history, a physical examination, blood pressure, risk assessment and medical advice. That combination is one of its strengths. A result is not considered in isolation, but alongside symptoms, family history, medication and examination findings.
For the routine laboratory component from age 35, the current directive lists a lipid profile with total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides, plasma glucose measured after fasting, and a urine dipstick test. The details are set out by Germany's Federal Joint Committee (G-BA).
A blood count, liver and kidney markers, thyroid markers or inflammation markers are therefore not automatically part of the standard scope. That does not mean they are never measured in primary care. When symptoms, existing conditions, medication or specific risks provide a reason, a doctor can order additional tests. The distinction is between a defined preventive-care programme for a broad population and individually indicated diagnostic testing.
Two assessments, two different jobs
The statutory check-up answers defined preventive-care questions. Additional biomarkers can add further layers.
STATUTORY CHECK-UP
History and examination Blood pressure and risk assessment Lipid profile and glucose Urine test and consultation
can be complemented by
ADDITIONAL BLOOD CONTEXT
Longer-term glucose Insulin regulation Atherogenic particle number Inflammation context Thyroid signal
Illustration, not patient data.
Takeaway. Check-up 35 is not a shortened complete analysis. It is a targeted preventive programme with a deliberately defined standard scope.
What HbA1c, insulin and HOMA add to glucose
Glucose is the outcome of a regulatory system. It shows how much glucose is available in the plasma at the time of the blood draw. HbA1c looks across a longer period because it reflects how much haemoglobin has become glycated over the preceding weeks. The two values are related, but they are not interchangeable.
A German population study from the KORA cohorts demonstrated this difference. Among participants who met diabetes criteria based on either glucose or HbA1c, only a small proportion met both at the same time. The overlap was also limited for prediabetes (Rathmann et al., 2012). In practice, this does not mean one test is better. They look at different parts of the same regulation.
Insulin adds another layer. Two people can have similar glucose values even though their bodies produce different amounts of insulin to maintain them. The HOMA index is calculated from glucose and insulin measured after fasting and provides a rough model estimate of insulin resistance. It is not a direct measurement, and there is no universal cut-off that applies regardless of laboratory, age and clinical context.
The combination can still be informative. In a 24-year cohort study, higher basal insulin among adults with initially normal glucose was associated with later deterioration in glucose regulation, even after several risk factors were taken into account (Dankner et al., 2009). This is an association, not a prediction for an individual. It does, however, explain why glucose alone cannot answer every metabolic question.
If you want to track your results over time, standardised conditions matter. Insulin and HOMA should be measured after fasting, and comparisons are more informative when timing, laboratory and preparation remain as similar as possible. You can find more practical guidance in our article on the first versus second blood test comparison.
Takeaway. Glucose shows the current outcome, while HbA1c reflects the longer-term pattern. Insulin and HOMA add context on how that outcome is being regulated.
How ApoB complements a standard cholesterol profile
The Check-up 35 lipid profile is a useful starting point. LDL cholesterol describes how much cholesterol is carried inside LDL particles. Non-HDL cholesterol broadens the view to additional cholesterol-containing particles. Triglycerides and HDL cholesterol help interpret the overall pattern.
Apolipoprotein B, or ApoB, answers a different question. Almost every atherogenic lipoprotein particle carries one ApoB molecule. The ApoB concentration therefore approximates the number of these particles. The amount of cholesterol carried by each particle can vary. Two people can have similar LDL cholesterol while one has more atherogenic particles in circulation.
The graphic simplifies this difference as fewer cholesterol-rich particles versus more cholesterol-poor particles. The relevant information for ApoB is the number of ApoB-containing particles. ApoB does not directly measure their size, and it includes other atherogenic lipoproteins as well as LDL.
The CARDIA study followed young adults over many years. Higher ApoB in young adulthood was associated with a greater likelihood of coronary artery calcium in midlife. This also applied when ApoB was high relative to LDL cholesterol (Wilkins et al., 2016).
ApoB does not diagnose atherosclerosis and does not replace the standard lipid profile. It can, however, reveal a mismatch that LDL cholesterol alone does not show. This may be particularly relevant when family history, triglycerides, glucose regulation or other risk factors do not seem to match the LDL cholesterol result.
A standard result can look unremarkable and still tell only part of the biological story.
Similar standard value, different context
LDL cholesterol and glucose show important outcomes. ApoB and insulin can add context on how those outcomes are produced.
Illustration, not patient data.
Takeaway. The standard profile describes how much cholesterol is being transported. ApoB adds context on how many atherogenic particles are involved.
What hs-CRP and TSH can make visible
High-sensitivity C-reactive protein, or hs-CRP, responds to inflammatory activity in the body. It may reflect low-grade systemic processes, but it is not specific. An infection, injury, chronic condition or an unusually intense training session can affect it. A single result cannot tell you where the response comes from or whether it persists.
In a large meta-analysis using data from 54 prospective studies, CRP was associated with later vascular events. A substantial part of this association, however, was linked to conventional risk factors and other inflammation markers (Kaptoge et al., 2010). That is why hs-CRP is a context marker rather than a standalone heart test. When a result is unexpectedly high, repeating it after an infection has resolved and without recent intense exercise may be more useful than drawing a quick conclusion.
TSH is the signal through which the pituitary gland regulates the thyroid. It can show altered regulation even when symptoms are nonspecific. European data suggest that undiagnosed hypothyroidism does occur, predominantly in subclinical patterns. The studies differed considerably in their populations and thresholds (Mendes et al., 2019).
Here too, TSH alone is not a complete thyroid assessment. Depending on the degree of change, symptoms, medication and medical history, an abnormal result may need to be repeated or followed by additional markers such as free T4. Conversely, a mildly altered value without matching clinical context should first be interpreted and monitored if needed. Its initial value is that it makes a signal visible that is not part of the routine Check-up 35 laboratory panel.
Takeaway. hs-CRP and TSH can make additional signals visible. Neither can identify the source of inflammation or diagnose a thyroid disorder on its own.
Which additional blood tests make sense for your baseline
The right question is not: How many markers can I measure? A better question is: What information am I missing right now? If you want to use statutory preventive care, start with Check-up 35 and a conversation with your GP. If you also want to document a broader starting point, you can choose markers that represent different systems and can later be repeated under similar conditions.
A metabolic baseline can combine glucose, HbA1c, insulin and HOMA. ApoB can add a particle perspective to the lipid profile. hs-CRP can add inflammation context, while TSH provides a thyroid signal. Liver, kidney and blood count markers can show how other organ systems contribute to the overall picture. No single marker is a verdict on your health.
A second measurement is often more valuable than the first because it turns a snapshot into a trend. In intervention studies, structured changes to diet and physical activity affected a range of metabolic and lipid markers. In a large trial of people who already had an increased risk of diabetes, an intensive lifestyle intervention substantially reduced diabetes incidence compared with placebo (Knowler et al., 2002). A Nordic dietary intervention improved selected lipid and inflammation markers in people with metabolic syndrome, but not every outcome that was measured (Uusitupa et al., 2013).
These results cannot be transferred directly to healthy people. They do show an important principle: lifestyle does not affect every marker in the same way, and your starting point influences what changes. A baseline is therefore less about finding a supposedly perfect value. It is about recognising a real change in your own context. You can find practical examples in our article on blood test results before and after lifestyle changes.
Three questions before an additional blood test
1
What question should the test answer? A clear purpose prevents the number of markers from becoming an end in itself.
2
Are the conditions comparable? Fasting status, exercise, infections, medication and time of day can affect results.
3
What happens if a result is outside the expected range? Unexpected results need a plan for repeat testing or medical follow-up.
Takeaway. The most useful assessment is not the one with the most markers. It is the one that fits your question and can later be repeated under comparable conditions.
Broader personal baseline
Holistic Core
Holistic Core combines 51 blood markers across metabolism, cardiovascular health, thyroid, liver, kidneys and blood count. This provides more context than a single glucose or cholesterol result without attempting to diagnose you remotely.
✓HbA1c, glucose, insulin and HOMA index
✓ApoB, hs-CRP and a complete lipid profile
✓TSH plus liver, kidney and blood count markers
✓Fast for over 12 hours; results in up to two working days
An additional blood test replaces neither Check-up 35 nor a medical examination. Abnormal or unexpected results should be assessed by a qualified healthcare professional.
Check-up 35 and additional blood tests: common questions
Which blood tests are included in Check-up 35?
From age 35, the routine laboratory component includes a lipid profile with total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides, plasma glucose measured after fasting, and a urine dipstick test. Additional markers can be ordered when medically indicated.
Does Check-up 35 include a full blood count?
No. A full or basic blood count is not automatically included in the standard scope. A doctor can order additional laboratory markers when symptoms, existing conditions or specific risks provide a reason.
Why isn't HbA1c included in Check-up 35?
The statutory standard uses plasma glucose measured after fasting as its glucose marker. HbA1c reflects a longer period and can add context, but it is not part of the routine Check-up 35 laboratory panel.
Which additional blood tests may be useful after 35?
That depends on the question. For a broader baseline, HbA1c, insulin with the HOMA index, ApoB, hs-CRP and TSH can add context. More markers are not automatically more useful.
Can an extensive blood test replace a Check-up 35 appointment with your GP?
No. Check-up 35 combines medical history, physical examination, blood pressure, risk assessment, consultation and laboratory testing. An additional blood test can add data, but it replaces neither the examination nor medical interpretation.
EN. This article is for informational and educational purposes only. It does not constitute medical advice, a medical opinion, or a diagnosis, and must not be used as a substitute for professional medical consultation, diagnosis, or treatment. Aware's blood testing services are designed to provide health data, not to diagnose or treat medical conditions. Always consult a qualified healthcare professional before making changes to your health routine or if you have concerns about any symptoms.
DE. Dieser Artikel dient ausschliesslich zu Informations- und Bildungszwecken. Er stellt keine medizinische Beratung, kein medizinisches Gutachten und keine Diagnose dar und darf nicht als Ersatz für eine professionelle medizinische Beratung, Diagnose oder Behandlung verwendet werden. Die Bluttestdienste von Aware sind dazu bestimmt, Gesundheitsdaten bereitzustellen, und dienen nicht der Diagnose oder Behandlung von Krankheiten. Bitte wende dich immer an eine qualifizierte Ärztin oder einen qualifizierten Arzt, bevor du Änderungen an deiner Gesundheitsroutine vornimmst oder wenn du Bedenken hinsichtlich deiner Symptome hast.
