Most people who miss NHS Health Checks are in their forties large-scale study finds
Researchers at Imperial College London’s Health Impact Lab found that people who did not attend an NHS Health Check had a 31 per cent higher risk of dying early, from any cause, and a nine per cent higher risk of experiencing a non-fatal heart attack or stroke for the first time, compared to those who attended the check-up.
The BHF urges people not to ignore their invitations for NHS Health Checks when they arrive, as the new results show the check-up could be lifesaving.
"A vital role"
Professor Bryan Williams, our Chief Scientific and Medical Officer, said:"NHS Health Checks play a vital role in helping people understand and reduce their risk of serious health problems before these develop, giving people the chance to take action and potentially prevent heart attacks, strokes and other cardiovascular disease."
"Worryingly, this study suggests that younger adults are among the least likely to attend. Many people in their forties are juggling busy lives, while others may wrongly assume that heart disease is something that only affects older people. We need to make it easier for people to attend these checks, because spotting problems early can save lives."
Introduced in 2009, the NHS Health Check is a free check-up offered every five years to people in England aged 40 to 74 without certain pre-existing health conditions. The appointment includes checks on blood pressure, weight and cholesterol, and assesses a person’s risk of developing cardiovascular disease, including coronary heart disease and stroke, as well as related conditions such as type 2 diabetes. Where appropriate, people can then be offered advice, lifestyle support, or treatment to reduce their future risk.
The researchers examined anonymised NHS records from the London Secure Data Environment health database for 925,072 people who were eligible for an NHS Health Check between 2015 and 2025, across eight boroughs in North West London. Fewer than half – 48 per cent – attended a Health Check.
The study highlights stark differences in attendance among various age groups. Almost 76 per cent of people who did not attend their Health Checks were aged 40 to 49. Almost 16 per cent of non-attendees were aged 50 to 59, just over seven per cent were aged 60 to 69, and just under two percent were aged 70 to 74. Men made up 60 per cent of people who did not attend.
Spotting problems early
The study results also illustrate how NHS Health Checks can uncover common health problems which can lead to cardiovascular disease, before they cause symptoms. Within 30 days of their check-up, 7,806 people who attended an NHS Health Check in North West London were found to have high blood pressure, 4,587 were diagnosed with type 2 diabetes, and 36,655 were defined as having a 10 per cent or greater risk of developing cardiovascular disease over the next decade.In many of these cases, these diagnoses allowed doctors to provide people with treatment and advice which reduced their risk of developing more serious health conditions. For example, 55 per cent of people with high blood pressure were able to reduce it to healthy levels within six months of their NHS Health Check.
Dr Saloni Nakhare, Health Impact Fellow at Imperial College London, and a BHF-funded PhD candidate, said: “Younger adults may not see themselves as being at risk of future health problems because they feel well. But conditions such as high blood pressure and raised cholesterol often have no symptoms, and cardiovascular risk can build silently over many years. What matters is that people can reduce their risk. When found, these conditions can usually be treated, and the earlier they are found, the longer someone has to benefit from that treatment."
The team, who were part-funded by the Cabinet Offices Evaluation Accelerator Fund (Phase 4), now want to find better ways of reaching people who currently miss out on NHS Health Checks, which could include invitation letters that explain why a Health Check is important, as well as digital reminders. NHS Health Checks available in alternative settings, or at a greater range of times, could also be a possible future option.
Dr Federica Re, Innovate MD Clinical Research Fellow at Imperial College London's Health Impact Lab and medical doctor, said: “These findings highlight a real opportunity to make NHS Health Checks even more effective by thinking differently about how they are offered. By using linked NHS data to understand who is currently being missed, we can make prevention of illness more personalised, more accessible, and ultimately more effective.”
Dr Patrik Bächtiger, Principal Investigator, said: “These findings strengthen the case for NHS Health Checks as an important way to improve long-term health. The next challenge is to make them reach the people who stand to benefit the most.”
Ben's story
Ben Aitken changed his life following an NHS Health Check in his forties.Alarmed by being given almost a one in five chance of having a heart attack or stroke in the next decade, he took immediate action and was able to reduce his risk within months.
Aged 42 when he had a Health Check at his local GP surgery in February 2022, Ben expected the results to show he was broadly healthy. He said: “When I was told of my risk of a heart attack or stroke, my greatest fear was that I would die. It was so much of a shock that I can’t even remember walking out of the doctor’s surgery. I went to my car and I burst into tears.
“Everything rushed through my head. I thought about my husband, David, who is deaf and relies on me for a lot of things, like telephone calls, doctor’s appointments and hospital checks. How would he manage if I was ill or died?”
The practice nurse at Ben’s health check told him his chances of having a heart attack or stroke in the next 10 years were higher than 18 per cent. Then she discussed some of the lifestyle improvements he could make to reduce the risk to his health.
The accountant, now aged 46, who is from Consett in County Durham, decided to make changes straight away.
Since his early twenties, he had been smoking around 20 cigarettes a day, but he started using nicotine patches and vaping instead. He downloaded the NHS stop-smoking app and found the regular messages about how his health was improving gave him the motivation he needed to cut down his smoking.
He then went to a stop-smoking clinic and he was able to stop completely.
Ben said: “I had never had much self-control, but the reality-check I got at the doctor’s changed everything. It gave me the will to stop.”
Ben also qualified for weight-loss medication and his GP prescribed him a tablet called Orlistat, which he took for two months, alongside a low-fat diet. He lost two stones (13kg) in that period. Motivated by his success, Ben then stopped taking the medication and joined a weight-loss group.
He said: “I absolutely love cooking, it's one of my big passions, but I changed what I was buying and cooking.
“I enjoyed it and saw it as a challenge. Rather than seeing it as having to give up things, I was enjoying the changes I was making in my life.”
Ben’s positive approach paid off. As part of managing his risk, Ben lost 38kg in the 13 months after his health check.
A follow-up appointment after Ben’s health check found his risk had reduced from more than 18 percent to 4.3 percent in just 10 months.
Now, almost four years later, and still taking statins to lower his high cholesterol, Ben is sticking to his new healthy habits.
He said: "If I'm honest, I spent years trying not to think about my own health. When you're overweight or know there are things you should be addressing, it's easy to bury your head in the sand and tell yourself that nothing bad is going to happen. You convince yourself that if you don't think about it, it somehow won't become a problem.
"Thank goodness I went to my Health Check, I dread to think what could have happened if I hadn't gone. It's far easier to prevent a heart attack or stroke than recover from one.
"I'd encourage anyone who's offered an NHS Health Check to take it. Getting checked can feel daunting, but knowing where you stand is far better than not knowing at all, and it could make a real difference to your future health."