A private heart health check in London, what it includes and who it suits

What a heart health check is

A heart health check estimates your chance of a heart attack or stroke over the coming years and finds the risk factors you can change. Most of that comes from your history, an examination, blood pressure and a blood test, with a risk tool that combines them into a single number.

In the UK, NICE recommends the QRISK3 tool to estimate the 10-year risk of heart disease and stroke for people aged 25 to 84 who do not already have it [1]. QRISK3 was built from the records of 7.89 million people in England and includes factors such as ethnicity, migraine, steroid use and severe mental illness [2].

Why it is done and who it is for

A check suits an adult who feels well and wants to know their risk, particularly with a family history of early heart disease, high blood pressure, raised cholesterol, diabetes or smoking. NICE advises reviewing heart risk on an ongoing basis for people over 40 [1].

The result guides treatment, and NICE recommends offering a statin to people whose 10-year QRISK3 score is 10% or more, after a conversation about benefits and risks [1]. In the United States, the USPSTF recommends a statin for adults aged 40 to 75 with a risk factor and a 10-year risk of 10% or more, and a selective offer between 7.5% and 10% [3].

Who it is not for

If you have chest pain, pressure or tightness, sudden breathlessness, or signs of a stroke, call 999 in the UK, or the local emergency number elsewhere. A planned check is never the right response to symptoms happening now, and new symptoms on exertion need a doctor promptly.

A risk score is not used for people already at high risk, such as those with type 1 diabetes, chronic kidney disease or familial hypercholesterolaemia, who need treatment planned directly [1]. People who have had a heart attack, a stent or bypass surgery do not need a calcium score [4].

Which tests a heart check includes

A full lipid profile measures total and HDL cholesterol and triglycerides, and calculates non-HDL and LDL cholesterol, and it does not need a fasting sample [1]. Our Longevity+ bloods add apolipoprotein B (ApoB) and lipoprotein(a), written Lp(a), to the standard profile, along with homocysteine and fasting insulin, for a fuller picture of cholesterol and metabolic risk [5].

• Blood pressure, weight and waist measurement
• A full lipid profile, with ApoB and Lp(a) where useful
• HbA1c for blood sugar, and kidney function
• An electrocardiogram (ECG) of the heart rhythm
• An echocardiogram if a murmur or symptom needs one
• A calcium score when your risk sits near a decision

When a calcium score helps

A calcium score is a short CT scan of the heart that measures calcified plaque in the coronary arteries, often before any symptoms. A score of zero suggests a low chance of a heart attack, a score of 100 to 300 means moderate plaque, and above 300 points to more extensive disease [4].

The European Society of Cardiology states that a calcium score can move a person’s risk up or down, and may be considered when calculated risk sits around a decision threshold [6]. It gives a dose of about 1.7 mSv [7].

Seeing plaque tends to change care. In the SCOT-HEART trial of 4,146 people with stable chest pain, adding CT imaging of the heart arteries led to more preventive treatment and fewer deaths from heart disease or heart attacks at 5 years, 2.3% against 3.9% [8]. Those were people with symptoms, so it does not show that scanning everyone helps.

Benefits, limitations and risks

A check gives you a clear picture of your risk and a plan to lower it. NICE notes that no risk tool is very good at separating who will and who will not have an event, so the number is a guide for a conversation [1].

A normal result can give false reassurance, and an abnormal one may lead to further tests. A calcium score involves a small dose of radiation, and statins carry a small risk of muscle aches, with severe muscle problems extremely rare [7] [1].

How you prepare and what to expect

Bring a list of your medicines, any earlier cholesterol results and what you know of your family history. Before a calcium score, avoid smoking and caffeine for a few hours, and the scan itself takes about 10 to 15 minutes [4].

The doctor goes through every result with you, gives you your risk in plain numbers and agrees what to change first.

• What is my 10-year risk, and what drives it?
• Would a calcium score change my treatment?
• Should I take a statin, and what are the trade-offs?
• Which change would lower my risk the most?

How The Wellness can help

The executive physical is a full day with one physician, £2,995, with advanced bloodwork, an ECG and body composition, results reviewed the same day and a written plan [9]. A calcium score is £750, and an echocardiogram reported by a consultant cardiologist is on our imaging page, each reported within 24 to 48 hours [10]. Longevity+ bloods with ApoB and Lp(a) are £1,395 [5].

Our clinics are on Baker Street in Marylebone and Eccleston Street in Belgravia, and every doctor is GMC registered.