The number of years people in the UK can expect to live in good health has fallen by approximately two years over the past decade, now standing at around 61, according to a report by The Health Foundation. While life expectancy continues to rise—to about 79 for men and 83 for women—individuals are experiencing more years of ill health. Professor Rob Galloway suggests that this trend is largely attributable to personal lifestyle choices rather than solely to the National Health Service (NHS).
Galloway emphasizes the importance of preventative health reviews, comparing the advice to 'be healthier' without guidance to telling someone to improve their finances without showing them their bank balance. He distinguishes between superficial "health MoT" packages and a "serious attempt to understand our individual risks and treat them before they cause ill health." Basic preventative measures include monitoring blood pressure, cholesterol, blood sugar levels, weight, and waist size.
The NHS Health Check, offered every five years in England to eligible adults aged 40 to 74, provides some of these basic checks. However, Galloway notes that it is not a comprehensive preventative assessment, as it prioritizes tests that are cost-effective for the entire population. He recommends considering additional, more detailed tests that are not routinely offered by the NHS, particularly from the age of 40 onwards, unless earlier screening is indicated by specific risk factors.
Advanced Cardiovascular and Metabolic Screenings
Deluxe cholesterol tests, such as Apolipoprotein B (ApoB) and Lipoprotein(a), can offer a more nuanced understanding of cardiovascular risk than standard cholesterol tests. ApoB, a protein found on cholesterol particles likely to clog arteries, can reveal a higher risk even if LDL cholesterol levels appear normal. A level above 1.0g/L is generally considered a higher risk, though ideal targets vary. Lipoprotein(a), which is largely determined by genetics, should be measured once, with levels below approximately 75nmol/L considered reassuring and above 125nmol/L as high. Elevated levels may necessitate more aggressive management of other cardiovascular risk factors.
A "smart" blood sugar check, including HbA1c, measures average blood sugar over two to three months. While below 42mmol/mol is normal in the UK, Galloway suggests aiming for levels comfortably below this and not trending upwards. Fasting insulin levels are also important, as they can rise before HbA1c indicates a problem, and can be improved with lifestyle changes, including reducing refined carbohydrates.
Tests for uric acid and homocysteine can provide further insights into cardiovascular and metabolic health. Elevated uric acid levels may indicate insulin resistance, while high homocysteine is also linked to cardiovascular risk. High-sensitivity C-reactive protein (CRP) serves as a broad marker for inflammation, and persistently raised levels can signal increased cardiovascular and metabolic risk.
Additional Health Monitoring
Galloway also advocates for regular full blood counts to detect conditions like asymptomatic anemia. A urine albumin-to-creatinine ratio (ACR) is recommended to identify early signs of kidney damage, which can be slowed with better blood pressure control. Liver function tests are crucial, especially given the rise in fatty liver disease, as elevated enzymes are an early indicator of potential problems.
Vital vitamin and hormone levels are also part of this preventative approach. A vitamin D blood test is advised for bone and muscle health. For men, testosterone levels may warrant discussion if symptoms of low testosterone are present. In women, hormone tests like FSH, LH, and estradiol may be justified for concerns related to irregular periods, menopause, or bone density.
Recommended Scans and Assessments
Beyond blood tests, certain scans and assessments are recommended every few years. An electrocardiogram (ECG) can detect atrial fibrillation, a significant stroke risk factor. A DEXA scan, performed every five to ten years, can diagnose osteoporosis and assess body composition. The VO2 max measurement, ideally tracked every three to six months, indicates how effectively the body uses oxygen during exercise and is a strong predictor of physical health and life expectancy.
A coronary artery calcium score, a low-dose CT scan performed every five to ten years, assesses plaque buildup in the coronary arteries. A high score indicates significant plaque accumulation and the need for more serious preventative measures. Galloway stresses that while standard NHS screenings remain important, these additional tests should be viewed as an investment in future health, emphasizing that the optimal time for prevention is before symptoms manifest and require emergency treatment.