NHS Health Check

After your NHS Health Check, you'll be given your cardiovascular risk of developing a heart or circulation problem (such as heart disease, stroke, type 2 diabetes or kidney disease) over the next 10 years.

The healthcare professional may describe this risk as low, moderate or high:

• low – you have less than a 10% chance of a heart or circulation problem in the next 10 years
• moderate – you have a 10% to 20% chance of a heart or circulation problem in the next 10 years
• high – you have more than a 20% chance of a heart or circulation problem in the next 10 years

Everybody's cardiovascular risk rises with age, so the next time you have an NHS Health Check your risk score may be higher, even if your test results remain the same.

There are some things about your risk which you cannot change, such as your age, ethnicity and family history. But the most important factors in your risk score (such as smoking, your cholesterol level and blood pressure) can be changed.

Your NHS Health Check results should also be broken down into:

• your body mass index (BMI)
• your blood pressure
• your cholesterol levels
• your alcohol use score
• your physical activity assessment result
• your diabetes risk assessment

You'll then have the chance to discuss how to improve your scores.

The NHS Health Check is also designed to find early signs of dementia.

At your NHS Health Check, sometimes your heart age is calculated using the heart age calculator. This tells you the age of your heart compared with your real age and can be really helpful in understanding risk. For example, while you might have been told your risk was low, you could have a heart age higher than your real age. This can often be lowered by making changes to your lifestyle.
You can calculate your heart age now.

People who have a BMI in the overweight or obese category are at greater risk of a range of serious health conditions, including heart disease, stroke, type 2 diabetes and certain cancers.

Reducing your BMI

If your BMI is higher than the healthy range (anything above 25, or anything above 23 if you have a south Asian background), you may be referred to a weight-management service that could help you to achieve a healthy weight, as well as looking at your diet and activity levels.

You can use the BMI healthy weight calculator to keep track of your BMI as your weight changes and to get advice on the best ways to achieve a healthy weight.

Underweight

A BMI below 18.5 indicates that you may be underweight. This could be a sign that you're not eating a healthy and balanced diet that contains enough energy for your needs. Or it may be a sign of a wide range of underlying health conditions.

When your blood pressure is measured, the reading has a higher and a lower number:

• your systolic blood pressure – this is the higher number indicating the pressure when your heart pumps blood out
• your diastolic blood pressure – this is the lower number indicating the pressure when your heart rests

Normal blood pressure is between 90/60 and 140/90. If your result are outside this normal range, the healthcare professional explaining your results will discuss this with you and what action to take.

High blood pressure (hypertension) is a problem because it increases the risk of serious health conditions such as heart attack, stroke, type 2 diabetes and kidney disease. High blood pressure usually causes no symptoms, so it's possible to have high blood pressure without knowing it.

Having a single raised blood pressure reading does not necessarily mean you have high blood pressure. Blood pressure can go up and down throughout the day and in response to stress.

If you have a raised blood pressure reading at your NHS Health Check, you may be given a blood pressure monitor to take home. Use this to see whether your blood pressure level is high at different times of the day over several days, which could indicate a health problem.

Reducing your blood pressure

Blood pressure can be brought down by making changes such as:

• being a healthy weight for your height
• being more active
• reducing salt in your diet (to no more than 6g a day)
• reducing your alcohol intake

If necessary, you may be prescribed blood pressure-lowering medicines. Depending on how high your blood pressure is, the health professional might want you to try making changes to your lifestyle first, before prescribing medicines.

Low blood pressure

Low blood pressure (hypotension) does not necessarily indicate a health problem and is typically only a problem when it's accompanied by symptoms, such as dizziness or fainting, which may be signs of a health condition.

Your cholesterol result will be broken down into:

• total cholesterol (TC) – healthy adults should have a total cholesterol of 5mmol/L or less
• HDL (called "good cholesterol") – this should be above 1mmol/L in men, and above 1.2mmol/L in women
• TC:HDL ratio – this is the ratio of HDL compared to TC and should be as low as possible. Above 6mmol/L is considered high

Lowering your cholesterol

If your cholesterol test results are outside the healthy range, your health professional will provide advice on how to lower your cholesterol through changes to your diet. They may also advise treatment with medicines, called statins.

You will be given a score for your alcohol use based on questions your healthcare professional asked you during your NHS Health Check. Your answer to each question will get a score from 0 to 4.

An alcohol use score of 7 or more would indicate that you are drinking an amount of alcohol that's likely to be harming your health. Your healthcare professional will be able to advise you on ways to track your drinking and to cut down on alcohol.

If your score is 20 or more, you may have an alcohol dependence disorder (alcoholism). Your healthcare professional should be able to refer you for specialist support for cutting down on alcohol.

As part of your NHS Health Check, your physical activity level will be measured and you will be given a score that is calculated using an internationally validated tool.

There is good evidence that taking part in moderate or vigorous physical activity every day can reduce your risk of more than 20 health conditions, from diabetes to dementia. It can also improve the management and reduce the risk of complications of many common conditions such as high blood pressure.

The Chief Medical Officer recommends that all adults should do some type of physical activity every day.

Adults aged 19 to 64 should:

• do at least 150 minutes of moderate intensity activity, or 75 minutes of vigorous physical activity, every week
• do regular muscle-strengthening exercise
• reduce the amount of time spent sitting or lying down

Adults aged 65 and older should:

• do at least 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity every week if already active, or a combination of both
• do activities that improve strength, balance and flexibility on at least 2 days a week
• reduce time sitting or lying down

If you are interested in increasing the amount of physical activity you do, you will be offered help and support to gradually increase your activity.

Your health professional will take your blood pressure and BMI test results into account to assess whether you're at an increased risk of developing diabetes.

You may be invited for another test to check that you do not have diabetes if:

• your diabetes risk assessment score is more than 5.6%
• your BMI is more than 30 (27.5 or more for Asian people), or
• your blood pressure is high (at or above 140/90mmHg), or where the systolic blood pressure or diastolic blood pressure exceeds 140mmHG or 90mmHg respectively

Quitting smoking

If you smoke, you should be offered support and advice as part of your NHS Health Check.

All areas have a free local NHS Stop Smoking Services, which can help you find your best way of stopping and provide the medicine and support you might need. You are up to 4 times more likely to quit if you use NHS support than if you try to do it alone.

To find your local service, call the NHS Smokefree national helpline on 0300 123 1044, go to the Smokefree website, or ask your healthcare professional to refer you to your local service.

Improving your fitness

Doing the recommended 150 minutes of your choice of exercise each week – such as walking, dancing or swimming – will help to bring your weight and blood pressure down, as well as having many other benefits for your wellbeing.

There are lots of resources to inspire you into getting fit your way on the NHS website. Try the NHS Couch to 5K running plan or a Fitness Studio exercise video today.

Losing weight

People with a high BMI are at greater risk of a range of serious health conditions, including heart disease, stroke and certain cancers.

If you would like help with losing weight, download the free NHS weight loss plan and start today.

Eating well

Eating a balanced diet, including vegetables, fruit and grains, plus some protein and dairy, will help you reduce your risk of cardiovascular disease.

The Eatwell Guide shows how much of what we eat overall should come from each food group to achieve a healthy, balanced diet.

Restricting your salt intake to no more than 6g each day can help your blood pressure readings come down. Find out more facts about salt.

When shopping for food, think about the food that you are buying and plan to stay within the recommended levels of calories, fats and salt. Learn more about how to make healthier food choices on our page about food labels.

Cutting back on alcohol

To reduce your risk of harming your health, including keeping your blood pressure in check, men and women are advised not to drink more than 14 units of alcohol each week on a regular basis.

Reducing your intake of alcohol and having several alcohol-free days a week will improve your overall health.

If your blood pressure was high, your healthcare professional may have offered you blood pressure-lowering medicines. Likewise, you may be prescribed cholesterol-lowering medicines. These medicines are usually taken as tablets.

These can have a very beneficial effect on your health, but you are likely to need to take them for a long time. Depending on your results, doctors will usually advise lifestyle changes first, to reduce your need for medicine and lower your risk of side effects from them, before prescribing these medicines.

Blood pressure medicines

Most people need more than 1 blood pressure medicine to help them manage their blood pressure.

Treatment for high blood pressure can include medicines such as:

• ACE inhibitors, which relax your blood vessels
• calcium channel blockers, which widen your arteries
• thiazide diuretics, which flush excess water and salt from the body
• beta-blockers, which reduce both your heart rate and the force at which blood is pumped around your body

Cholesterol-lowering medicines

The most commonly prescribed cholesterol-lowering medicines are called statins.

Statins can be prescribed to help lower high cholesterol, whether it's caused by a lack of exercise or a diet high in fat.

They can also help people who have an inherited condition that causes to much cholesterol in their blood (this is called familial hypercholesterolaemia).

Ask a pharmacist

A local pharmacist is a trained expert in medicines and can provide information and advice about your medicines, including how to take them and what to do if you have any side effects.