What it measures

The pressure in your arteries, given as two figures. The first is the pressure when your heart pumps, and the second is the pressure when it rests between beats.

Why it is in the check-up

High blood pressure does not usually cause symptoms, so the only way to find it is to measure it. Untreated, it raises the risk of heart attack, stroke, heart failure and kidney disease.

The British Heart Foundation estimates that as many as five million adults in the UK have high blood pressure without knowing it, and calls it the leading modifiable risk factor for cardiovascular disease in the UK.

What the result can and cannot show

A reading of 140/90 mmHg or higher, taken by a healthcare professional, counts as high.

One raised reading is not a diagnosis. NICE asks for it to be confirmed with a monitor worn through the day or with readings taken at home, where an average of 135/85 mmHg or higher confirms it.

What it measures

Your weight in kilograms divided by the square of your height in metres. The result is your body mass index, or BMI.

Why it is in the check-up

Height and weight are measured in the NHS Health Check, which looks for a higher risk of heart disease, stroke, diabetes and kidney disease. Around three in ten adults in the UK have obesity, and more than one in three are overweight, according to the British Heart Foundation.

What the result can and cannot show

For most adults the NHS counts a BMI of 25 to 29.9 as overweight and 30 or more as obese. The thresholds are lower, at 23 and 27.5, for people of South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean background.

BMI cannot tell muscle from fat, and it does not show where fat is carried, which is why your waist is measured too.

What it measures

Your resting heart rate, counted while your blood pressure is taken.

Why it is in the check-up

A resting pulse is the simplest measure of the heart at rest, and it is taken at the same time as your blood pressure. An irregular pulse can be the first sign of an irregular rhythm, which may cause no symptoms at all.

What the result can and cannot show

A single reading is a snapshot: a pulse rises with anxiety, caffeine and exertion. An irregular pulse is for a doctor to interpret, and the ECG records the rhythm properly.

What it measures

Total cholesterol, HDL cholesterol and triglycerides are measured, and non-HDL and LDL cholesterol are worked out from them. LDL is the main source of blockages in the arteries. HDL is often called “good” cholesterol, because it helps to clear LDL.

Why it is in the check-up

High cholesterol is very common, and most people do not know they have it, because it does not usually cause symptoms. The excess is laid down in the walls of the arteries as fatty plaques, which stiffen and narrow them. This can lead to heart attacks and strokes, says the charity HEART UK.

The British Heart Foundation estimates that around half of adults in the UK have a total cholesterol above 5 mmol/L.

What the result can and cannot show

The NHS gives healthy levels for adults as a total cholesterol below 5 mmol/L and a non-HDL cholesterol below 4 mmol/L.

The figures are not a verdict on their own. A doctor reads them with your age, your blood pressure and your other results to estimate your risk over the next ten years. NICE asks for that estimate to be made with the QRISK3 tool, and for a statin to be offered when the risk is 10% or more.

What it measures

Apolipoprotein B, one molecule of which sits on every particle that can lodge in an artery wall, and apolipoprotein A1, the main protein of HDL, with the ratio between them.

Why it is in the check-up

A cholesterol profile measures how much cholesterol the particles carry; apolipoprotein B counts the particles. Two people with the same LDL cholesterol can carry very different numbers of particles, and the count tracks risk at least as well as the cholesterol level.

European guidelines name apolipoprotein B as an alternative to LDL cholesterol for measuring risk, and say it may be preferred in people with diabetes, obesity or very low LDL.

What the result can and cannot show

These are risk markers, read with everything else; neither is a diagnosis. There is no single threshold in UK practice, because UK risk tools are built on cholesterol rather than on particle counts.

The ratio is a derived figure, and a derived figure inherits the uncertainty of both measurements. Your doctor reads it alongside your cholesterol profile, not instead of it.

What it measures

Lipoprotein(a) is a large particle, made by the liver, that carries cholesterol. Its level is set mainly by your genes, and diet and exercise change it very little.

Why it is in the check-up

A high level is a risk factor for diseases of the heart and blood vessels. It does not usually cause symptoms, and it is not part of an ordinary cholesterol test, so only this test shows it. About one adult in five has a raised level, the US National Lipid Association estimates.

American guidelines now recommend measuring it at least once in every adult: the National Lipid Association in 2024, and the American College of Cardiology and American Heart Association in 2026.

What the result can and cannot show

The National Lipid Association counts a level below 75 nmol/L as low risk, 75 to 125 as intermediate and 125 or more as high risk. UK laboratories and doctors may use the different bands published by the charity HEART UK.

The figure is a measure of inherited risk, for your doctor to weigh with everything else. It is not a diagnosis.

Because the level changes little through life, we leave the test out if yours has been measured before.

What it measures

HbA1c is glycated haemoglobin: glucose that has attached itself to your red blood cells. It reflects your average blood sugar over the last two to three months. No preparation is needed.

Why it is in the check-up

Diabetes UK estimates that almost 1.3 million people in the UK have type 2 diabetes that has not been diagnosed. Prediabetes does not usually cause symptoms.

Adults with diabetes are three to five times more likely to die of cardiovascular disease than adults without it, according to the British Heart Foundation.

What the result can and cannot show

Below 42 mmol/mol is normal, 42 to 47 is the range known as prediabetes, and 48 or above is the level used to diagnose diabetes.

In a person without symptoms, one result of 48 or more is not a diagnosis: the test is repeated first. A result below 48 does not by itself rule diabetes out.

What it measures

C-reactive protein is made by the liver in response to inflammation. The high-sensitivity test measures very small rises in it.

Why it is in the check-up

The test is used to estimate the risk of heart disease. American and European guidelines count a level that stays at 2 mg/L or above as a factor that raises a person’s risk.

In 2025 a scientific statement from the American College of Cardiology called for the test to be used widely, together with LDL cholesterol.

What the result can and cannot show

The American Heart Association reads a level below 1 mg/L as low risk, 1 to 3 as average and above 3 as high.

The test is not specific to the heart: it shows inflammation anywhere in the body, and not its cause. An infection or another source of inflammation raises it. A level above 10 mg/L is repeated, and a single result is a snapshot: the Association advises measuring twice, two weeks apart.

What it measures

Troponin is a protein found in heart muscle. The high-sensitivity test measures very small amounts of it in the blood.

Why it is in the check-up

In a hospital, troponin is the test that confirms a heart attack. Our doctors put it on the list on the reasoning that, in a person who feels well, a level at the upper end of the normal range marks a higher risk later. That is their judgement rather than a guideline position, and no guideline we have found endorses the test for people without symptoms.

It is the one test here that looks at the heart muscle itself rather than at a risk factor for it.

What the result can and cannot show

In someone without symptoms this is a risk marker, not a diagnosis, and it is not what the test was designed for. A level inside the reference range is reassuring about today and says little about any particular tomorrow.

A raised level has many causes besides the heart: kidney disease, a fast rhythm, heavy exercise in the days before, and inflammation. A raised result in a well person usually leads to a repeat test and a cardiology opinion, and that chain is a real cost of measuring it.

If you have chest pain, this check-up is not the right route: that needs urgent assessment, not a scheduled test.

What it measures

NT-proBNP, a fragment released when the muscle of the heart is stretched or under strain. One blood test.

Why it is in the check-up

It is the blood test NICE uses in the assessment of suspected heart failure: a normal level makes heart failure unlikely, which is what makes it useful as a baseline.

Heart failure develops quietly, and breathlessness is easy to attribute to age or weight. A figure recorded while you feel well is the comparison for any figure measured later.

What the result can and cannot show

A normal level is the useful result: it makes heart failure unlikely. A raised level is not a diagnosis of anything by itself.

The level rises with age, with kidney disease and with atrial fibrillation, and falls with obesity, so it is read in the light of all of those. Where it is raised, the next step is an echocardiogram, which this check-up already includes.

What it measures

The number and size of the cells in your blood, including your haemoglobin, and the erythrocyte sedimentation rate: the time your red blood cells take to settle at the bottom of a tube.

Why it is in the check-up

A full blood count is the test that shows anaemia, and it is the broadest single look at the blood: the red cells that carry oxygen, the white cells that fight infection and the platelets that help blood to clot.

The sedimentation rate is added to it. It rises when there is inflammation anywhere in the body, and it is one of the oldest and least specific markers in medicine.

What the result can and cannot show

A low haemoglobin or red cell count may be a sign of anaemia; the count does not show its cause.

A raised sedimentation rate means inflammation somewhere, not where or why. It rises with age, in women, in pregnancy and with anaemia, so it is read with everything else and never alone.

What it measures

Creatinine and urea, the waste products the kidneys clear, with the estimated glomerular filtration rate (eGFR) worked out from them; the liver enzymes ALT and AST; and the salts the kidneys balance, sodium and potassium.

Why it is in the check-up

People with kidney disease, even when it is mild, are at higher risk of heart attack and stroke, says the NHS, and the British Heart Foundation estimates that around 7.2 million people in the UK are living with chronic kidney disease. NICE asks for kidney function to be measured in everyone with high blood pressure.

The liver enzymes are one of the baseline tests NICE asks for before a statin is started, and liver disease is one of the causes of abnormal cholesterol NICE asks doctors to exclude. Potassium matters because several of the drugs used for blood pressure move it.

What the result can and cannot show

Healthy kidneys filter more than 90 ml a minute. A figure between 60 and 89 counts as kidney disease only when other tests also show signs of damage.

The panel shows whether each level sits inside the laboratory’s reference range, not why one does not. Meat eaten in the 12 hours before the test can affect the kidney result, which is why we ask you to avoid it.

What it measures

A prothrombin time, which measures the seconds a clot takes to form, reported with the international normalised ratio (INR), together with the activated partial thromboplastin time and, in most panels, fibrinogen.

Why it is in the check-up

A coagulation screen measures how long your blood takes to clot. It is the baseline a doctor wants before any question of clotting arises.

Clotting is what turns a narrowed artery into a blocked one. The screen does not predict that, but it records how your blood clots now, before any treatment is considered.

What the result can and cannot show

The screen shows whether clotting is slower or faster than the reference range. It does not explain why, and it is not a test for an inherited clotting disorder: that needs its own tests, which we do not arrange.

The numbers move with illness, with vitamin K and with any anticoagulant you take, so tell your coordinator about every medicine.

What it measures

Four results from one sample: thyroid-stimulating hormone, made by the pituitary gland, which tells the thyroid how much hormone to make; free thyroxine (free T4) and free triiodothyronine (free T3), the active hormones in the blood; and antibodies to thyroid peroxidase (anti-TPO), the sign that the immune system is attacking the gland.

Why it is in the check-up

Thyroid disease is common and its symptoms are vague: tiredness, weight change, feeling cold or hot, low mood, a fast or slow pulse.

Both an underactive and an overactive thyroid change the heart: the rate, the rhythm and the cholesterol level. An untreated thyroid disorder can raise cholesterol, which is one of the causes NICE asks doctors to exclude before treating a raised level.

What the result can and cannot show

TSH outside its range, read with free T4 and free T3, shows an underactive or an overactive thyroid. The tests do not show the cause; the antibodies help, because they point to autoimmune thyroid disease.

Antibodies can be present in people whose thyroid works normally, and they are not in themselves a disease. Severe illness, pregnancy, biotin supplements and some medicines, including the contraceptive pill and steroids, change the readings.

What it measures

Lipoprotein-associated phospholipase A2, an enzyme carried on LDL particles and found in the plaque inside artery walls, measured by the test sold as the PLAC test; and magnesium measured inside the red blood cells rather than in the serum around them.

Why it is in the check-up

Both are on the list our doctors drew up. Lp-PLA2 is a marker of inflammation specific to the artery wall, which is what distinguishes it from C-reactive protein, a marker of inflammation anywhere.

Red-cell magnesium is argued to reflect the body’s magnesium stores better than the usual serum measurement, because most of the body’s magnesium sits inside cells.

What the result can and cannot show

These are the two weakest tests in the check-up, and we would rather say so than imply otherwise. No guideline recommends either for people without symptoms, and the evidence that measuring them changes what a doctor does is thin.

Both need days rather than hours in the laboratory: Lp-PLA2 has a published turnaround of two days, and the red-cell measurement is sent with it. Your other results reach you on the day; these two follow, and your summary is reissued with them.

What it measures

An ECG records the electrical activity of your heart, including its rate and rhythm. Small sticky patches are placed on your arms, legs and chest, and you lie still for a few minutes. It is quick and painless.

Why it is in the check-up

It can show a problem with how quickly or regularly the heart beats, and signs of an earlier heart attack. One rhythm problem, atrial fibrillation, sometimes causes no symptoms and is found at a routine check-up; people with it are up to five times more likely to have a stroke if their risk is not managed, according to the British Heart Foundation.

A resting ECG also gives your doctor a baseline to compare with in later years.

What the result can and cannot show

A resting ECG records only a few minutes, so a rhythm problem that comes and goes may not appear on it. An abnormal tracing does not always mean that something is wrong with the heart, and it can lead to further tests that find nothing.

What it measures

An echocardiogram is a scan of the heart, made with ultrasound. It shows the structures of the heart, such as the valves, how blood flows through it and how well it is pumping. The scan takes about 30 to 40 minutes and uses no radiation.

Why it is in the check-up

It is the test used to diagnose heart valve disease and heart failure, and some people with valve disease have no symptoms.

In the OxVALVE study, 2,500 people aged 65 and over, drawn from general practice, were scanned. Valve disease that had not been diagnosed was found in 51% of them. Most of it was mild; in 6.4% it was moderate or severe. The study did not include people under 65.

What the result can and cannot show

It shows the structure of the heart and how it is working on the day of the scan: a baseline, not a prediction. In the OxVALVE study most of what was found was mild. What a finding means for you is for a doctor to say.

What it measures

Your age, sex, blood pressure, cholesterol and the rest, put through the risk tools the guidelines use: QRISK3, which NICE asks for in the UK, and the European SCORE2. Your summary states the figures and the inputs they came from.

Why it is in the check-up

A single result means little on its own; what matters is the whole picture. The point of measuring ten things in one morning is that they can then be read together.

NICE asks for cardiovascular risk to be estimated with QRISK3, and for a statin to be offered when the ten-year risk is 10% or more. That is the number a GP will want, and your summary hands it over with its workings.

What the result can and cannot show

A risk score is a population average for people like you, not a forecast for you. It is built from the inputs given to it, and a tool built on one population performs differently on another.

The score cannot include the markers this check-up adds beyond its inputs: a calcium score, apolipoprotein B or Lp(a) may all move a doctor’s judgement without moving the number. The figure is a starting point for a conversation, not its conclusion.

What it measures

A duplex ultrasound scan of the arteries in the neck: it shows the artery wall and measures the speed of the blood through it. About 30 minutes, no radiation.

Why you might add it

Plaque in the neck arteries is the same disease as plaque in the heart, in a place ultrasound can see. Where it is found, it tells a doctor that the process is under way.

What the result can and cannot show

Narrowing found in someone without symptoms rarely calls for treatment of the artery itself; what it changes is how hard the risk factors are treated. The UK National Screening Committee does not recommend screening for carotid disease.

What it measures

An ultrasound scan of the thyroid gland and the neck. About 20 minutes, no radiation.

Why you might add it

The blood tests in the check-up show how the thyroid is working; a scan shows what it looks like. Where the blood tests or the antibodies are abnormal, the scan is the natural next look.

What the result can and cannot show

Small thyroid nodules are very common and almost always harmless; finding one often leads to repeat scans and sometimes to a needle test that was never needed. That is why this is an addition and not part of the check-up.

What it measures

A Doppler ultrasound scan of the arteries and veins of one or both legs, with the ankle pressures where they are needed.

Why you might add it

Narrowed leg arteries are the same disease again, and the classic symptom — calf pain on walking that eases with rest — is easy to mistake for age or a bad back.

What the result can and cannot show

In someone with no symptoms the scan rarely changes treatment. Varicose veins found incidentally are a cosmetic matter unless they are causing trouble.

What it measures

A small monitor worn on a belt, with a cuff on the arm, which takes a reading every 20 to 30 minutes through the day and less often at night. You return it the next day.

Why you might add it

It is what NICE asks for to confirm high blood pressure, because one reading in a clinic is not enough. It also shows whether the pressure falls at night, which a single reading cannot.

What the result can and cannot show

An average of 135/85 mmHg or higher during the day confirms high blood pressure. The monitor is mildly uncomfortable and interrupts sleep. If your reading on the day is normal, you probably do not need it.

What it measures

A small recorder worn for 24 hours with patches on the chest, which records every beat. You return it the next day.

Why you might add it

The resting ECG in the check-up records a few minutes. A rhythm problem that comes and goes — atrial fibrillation above all — will not appear on it, and 24 hours catches a good deal more.

What the result can and cannot show

Even 24 hours can miss an intermittent rhythm; longer recordings exist for that reason. Occasional extra beats are found in almost everyone and are usually of no consequence.

What it measures

An ECG and your blood pressure recorded while you walk on a treadmill that gets steeper and faster, until you reach a target heart rate or have to stop. It takes 30 to 60 minutes with the preparation.

Why you might add it

A resting ECG shows the heart at rest. This shows it under load, which is when a narrowed artery first fails to keep up, and it also measures how much work you can do — in itself one of the better predictors of what follows.

What the result can and cannot show

In people without symptoms it produces a good many false alarms, and NICE no longer uses it to investigate suspected angina: for chest pain the NHS route is a CT coronary angiogram.

It is not suitable for everyone: it needs you to be able to walk briskly, and the clinic screens you first. If you have chest pain on exertion, this is not the route — see a doctor.

What it measures

A CT scan of the heart, without any injection, that measures calcified plaque in the coronary arteries. The amount is given as a calcium score. The scan takes less than 20 minutes.

Why you might add it

Calcium in the coronary arteries is a marker of coronary artery disease, whether or not there are symptoms. In a study of 6,722 men and women aged 45 to 84, followed for a median of 3.8 years, people with a score of 101 to 300 were 7.7 times as likely to have a coronary event as people with no calcium, and people with a score above 300 were 9.7 times as likely.

American guidelines recommend the score for adults at borderline or intermediate risk, men from 40 and women from 45, when it is uncertain whether to start treatment. With a score of zero, the chance of a heart attack in the next two to five years is very low.

What the result can and cannot show

The words used in reports are shown below; the study on the evidence page grouped scores a little differently. The scan has limits: it does not measure softer plaque that has not yet calcified, it does not show whether an artery is narrowed, and disease can be present without calcium, especially under the age of 50.

It uses X-rays. A typical dose is about 1.7 mSv; set against the UK average of 2.1 mSv a year from natural background radiation, that is roughly ten months’ worth. That is why it is an addition rather than part of the check-up, why it is not offered under 46, and why it is not repeated within five years of a normal scan.

What it measures

An MRI scan covering, in most packages, the brain, the chest, the abdomen, the pelvis and the spine. It takes about an hour, and it uses no radiation.

Why you might add it

It is the broadest look at the body that can be had without X-rays, and it is on the list of additions our doctors drew up. People choose it to see everything at once.

What the result can and cannot show

It is not a screening test for cancer, and no screening body recommends one for people without symptoms. Its weakness is the mirror of its breadth: in a well person most of what it finds is of no consequence, and each finding has to be chased down.

Expect findings. A scan of this kind commonly shows cysts, small nodules and wear in the spine, and sorting the harmless from the important takes more tests, more time and more money.

What it measures

The levels of two substances in your urine, albumin and creatinine. The result is given as their ratio, the ACR. It shows whether protein is leaking into the urine.

Why you might add it

It is one of the two tests the NHS uses to look for kidney disease, and it can be abnormal while the blood test is still normal. NICE asks for it in everyone with high blood pressure, and treats albumin in the urine as a sign of high cardiovascular risk.

What the result can and cannot show

The NHS reports the ratio in three bands: below 3 mg/mmol, 3 to 30, and above 30. NICE regards a confirmed ratio of 3 mg/mmol or more as clinically important.

One raised result is not a diagnosis. NICE asks for a result between 3 and 70 mg/mmol to be confirmed on a second, early-morning sample.

What it measures

Vitamin D, which regulates the calcium and phosphate that keep bones, teeth and muscles healthy; vitamin B12; and folate. Three results from the same blood sample.

Why you might add it

A low vitamin D level is common in the UK: in the National Diet and Nutrition Survey, 18% of adults aged 19 to 64 had a level below 25 nmol/L, the level below which the risk of poor bone and muscle health is considered to rise.

B12 and folate are measured with it because a shortage of either causes anaemia, and because tiredness has several possible explanations. All three come from the sample already being taken.

What the result can and cannot show

Each shows your level on the day of the test and no more. Vitamin D is lowest from January to March, so a low result in February says less than the same result in August.

A low B12 or folate is a finding to act on; a normal one does not rule out every cause of tiredness. Whatever your vitamin D result, UK government advice is that everyone should consider a daily supplement in autumn and winter.