Key Facts

The NHS Health Check is a national cardiovascular disease prevention programme. It identifies individuals at risk and offers interventions to reduce future CVD events. It is one of the largest systematic risk assessment programmes worldwide.

Epidemiology

• CVD is the leading cause of death globally and second in the UK (approximately 160,000 deaths/year)
• 15 million people eligible in England
• Uptake: approximately 40-50% (target is higher)
• CVD is largely preventable: 80% of premature CVD events are attributable to modifiable risk factors

Programme Components

• Age 40-74 without known CVD, diabetes, CKD stage 3-5, AF, or statin use
• Every 5 years
• Risk assessment using QRISK3 (incorporates age, sex, ethnicity, smoking, BP, cholesterol, diabetes, AF, rheumatoid arthritis, CKD, BMI, family history, deprivation)

Risk Factor Assessment

• Blood pressure, cholesterol (total, HDL), HbA1c/fasting glucose, BMI, waist circumference, smoking status, alcohol intake, physical activity, family history
• Additional: pulse palpation for AF, dementia awareness (≥65), mental wellbeing

Assessment Components

• Blood pressure measurement (seated, calibrated device)
• BMI calculation and waist circumference
• Non-fasting lipid profile (total cholesterol, HDL cholesterol, non-HDL cholesterol)
• HbA1c or fasting glucose
• Kidney function (eGFR, urine ACR if indicated)
• Pulse palpation (AF screening)
• Smoking status assessment
• Alcohol intake assessment (AUDIT-C)
• Physical activity assessment
• Family history of CVD, diabetes
• Dementia awareness discussion (age ≥65)

Risk Stratification

• QRISK3 <10%: lifestyle advice, repeat in 5 years
• QRISK3 10-20%: lifestyle modification + offer statin therapy (atorvastatin 20mg OD)
• QRISK3 ≥20%: intensive lifestyle modification + statin therapy

Red Flags Identified at Health Check

• BP ≥180/110 mmHg — urgent assessment and management
• HbA1c ≥48 mmol/mol — diabetes diagnosis; manage per NICE NG28
• AF detected — manage per NICE NG196
• eGFR <60 or ACR ≥3 mg/mmol — CKD management per NICE NG203

Bedside

• Blood pressure (automated validated device)
• BMI and waist circumference
• Pulse palpation for rhythm

Bloods

• Non-fasting lipid profile: total cholesterol, HDL cholesterol
• HbA1c (preferred) or fasting glucose
• eGFR (U&Es)
• Urine ACR if eGFR borderline or diabetes suspected

Risk Calculators

• QRISK3: 10-year cardiovascular risk percentage
• Inputs: age, sex, ethnicity, postcode (deprivation), smoking, diabetes, AF, RA, CKD, BP, cholesterol ratio, BMI, family history of CVD <60

Follow-up Tests

• ECG: if irregular pulse detected
• ABPM: if clinic BP ≥140/90 mmHg (to confirm hypertension per NICE NG136)
• Repeat HbA1c: to confirm diabetes diagnosis

Lifestyle Interventions (for all)

• Smoking cessation (referral to stop smoking service)
• Diet: Mediterranean-style, reduce saturated fat, increase fruit/vegetables, reduce salt <6g/day
• Physical activity: ≥150 minutes moderate-intensity aerobic activity per week
• Weight management: aim healthy BMI (18.5-24.9); refer to weight management programme if BMI ≥30
• Alcohol: within 14 units/week, spread over 3+ days

Pharmacological

Lipid management (NICE CG181):

• QRISK3 ≥10%: offer atorvastatin 20mg OD after informed discussion
• Re-check lipids at 3 months; aim for ≥40% reduction in non-HDL cholesterol
• If ≥40% reduction not achieved: discuss adherence, lifestyle, consider increasing dose (up to 80mg)

Hypertension (NICE NG136):

• Confirm with ABPM
• Stage 1 (≥140/90 clinic, ≥135/85 ABPM): treat if QRISK3 ≥10%, target organ damage, CKD, or diabetes
• Stage 2 (≥160/100): treat all
• First-line: ACEi/ARB (<55 years, non-Black); CCB (≥55 years or Black African/Caribbean)

Non-diabetic hyperglycaemia:

• Refer to NHS Diabetes Prevention Programme (intensive lifestyle intervention)
• Repeat HbA1c annually

Diabetes:

• Manage per NICE NG28 (metformin first-line, HbA1c target individualised)

Referral Criteria

• Familial hypercholesterolaemia suspected: lipid clinic
• QRISK3 ≥20% with additional concerns: cardiology/specialist
• Diabetes diagnosed: structured education (DESMOND/DAFNE)
• AF detected: ECG, manage per NICE NG196, consider cardiology

• Statin therapy: reduces CVD events by approximately 25-35% over 5 years for primary prevention
• Blood pressure treatment: each 10mmHg systolic reduction lowers stroke risk by 27% and coronary events by 20%
• NHS Health Check programme: estimated to prevent 1,600 heart attacks, 960 strokes, and 4,000 diabetes cases annually
• Non-diabetic hyperglycaemia: without intervention, 5-10% progress to diabetes per year; NHS DPP reduces this by 50%
• Smoking cessation: halves CVD risk within 1 year; returns to non-smoker level within 5-15 years
• Programme impact: modelling suggests potential to prevent 20,000 CVD events per year if fully implemented with high uptake

QRISK3 Score Interpretation

HbA1c Interpretation