A heart and metabolic health consultation, and what happens next

What the consultation is

A heart and metabolic health consultation looks at the connected conditions that lead to heart disease and type 2 diabetes, and treats them as one picture. Blood pressure, cholesterol, blood sugar, weight around the waist, smoking, sleep and family history all feed the same risk, and a change in one often moves the others.

Our guide to a private heart health check explains the tests and when a calcium score helps. Here we cover the consultation itself, what the numbers mean and how a plan is followed through.

Why it is done and who it is for

It suits an adult with a raised reading from a check elsewhere, a family history of early heart disease or diabetes, a waist that has grown over the years, or a wish to know where they stand. NICE advises reviewing heart risk on an ongoing basis for people over 40 [1], and encourages a type 2 diabetes risk assessment for adults aged 40 and above, or from 25 for people of South Asian, Chinese, African-Caribbean or Black African family origin [2].

The numbers a doctor looks at

Each measurement has a threshold that guides the next step, and the doctor reads them together.

• Blood pressure, where a clinic reading of 140/90 or higher is confirmed with home or ambulatory monitoring before hypertension is diagnosed [3].
• Cholesterol, measured as total and HDL cholesterol, with specialist review if total cholesterol is above 9.0 mmol per litre or non-HDL cholesterol above 7.5 [1].
• Blood sugar, where an HbA1c of 42 to 47 mmol/mol marks a high risk of type 2 diabetes and 48 or more suggests diabetes itself [2].
• Waist-to-height ratio, where 0.5 to 0.59 means increased health risk and 0.6 or more means a further increased risk [4].
• A 10-year risk score from QRISK3, which NICE recommends for adults aged 25 to 84 without heart disease [1].

What the plan usually includes

The plan starts with the changes that move several numbers at once, such as more activity, a change in diet, less alcohol, better sleep and stopping smoking. The evidence for this is strong. In the Diabetes Prevention Program, adults at high risk who aimed for 7% weight loss and 150 minutes of activity a week lowered their rate of type 2 diabetes by 58% compared with placebo, over an average of 2.8 years [5].

Medicine is added where the risk is high enough. NICE recommends offering atorvastatin 20 mg when the 10-year risk is 10% or more, aiming for a reduction in non-HDL cholesterol of more than 40% [1]. The US Preventive Services Task Force reaches a similar view for adults aged 40 to 75 with at least one risk factor and a 10-year risk of 10% or more [6]. Blood pressure treatment aims for a clinic reading below 140/90 in adults under 80 [3].

Who it is not for

If you already live with heart disease or diabetes, your care follows a treatment plan rather than a risk score. NICE advises against using a risk tool for people already at high risk, such as those with type 1 diabetes, reduced kidney function, familial hypercholesterolaemia or another inherited lipid disorder [1].

If you have chest pain, sudden breathlessness, weakness of the face or an arm, or difficulty speaking, call 999 in the UK or the local emergency number elsewhere [7].

Benefits and limitations

The benefit is that the risks you can change are found early and handled together, by one doctor who explains how each choice affects the others. Risk scores guide decisions, and NICE notes that no tool is very good at telling exactly who will and who will not have a heart attack or stroke, though tools are useful for guiding decisions [1].

Medicines can have side effects, and a single high reading can mislead, so the doctor repeats measurements before acting and explains each decision before you make it.

How follow-up works

A plan works when it is checked. After starting or changing a cholesterol medicine, NICE advises measuring lipids again at 2 to 3 months [1]. For people at moderate risk of diabetes, it suggests reassessment at least every 3 years [2], and when blood pressure is normal it advises measuring it at least every 5 years [3].

• What is my 10-year risk, and what would lower it most?
• Which of my numbers matters most right now?
• Would a medicine help me, and what are its side effects?
• When should we measure again, and what would change the plan?

How The Wellness can help

The executive physical gives you a full day with one physician, with advanced bloodwork, an ECG and body composition, your results reviewed the same day and a written plan. The Longevity+ blood test adds ApoB, Lp(a), homocysteine and fasting insulin for a closer look at inherited and metabolic risk. If you have one specific question, a GP appointment is the simpler place to start, with a doctor who can prescribe and refer you to a named specialist [8].

Our clinics are on Baker Street in Marylebone and Eccleston Street in Belgravia, open 7am to 9pm every day, and a doctor can come to your home or hotel in London.