# Potential of earlier primary care health checks for prevention of cardiovascular events in younger age groups: population-based study in the United Kingdom

## TL;DR

This study examines whether earlier health checks in younger adults could prevent cardiovascular events, finding that many had treatable risk factors but low predicted risk scores.

## Contribution

The study evaluates the potential effectiveness of lowering the age for NHS health checks to 30 years by analyzing real-world data on vascular events in younger adults.

## Key findings

- Most vascular events in 30–44-year-olds occurred in individuals with treatable risk factors above target levels.
- However, 95% of these individuals had predicted 10-year cardiovascular risks below the 10% threshold for active risk management.
- The average 'healthy heart age' gap was 9 years, suggesting room for risk reduction even with low absolute risk scores.

## Abstract

Incidence of stroke and certain cancers is increasing at younger ages in many high-income countries, prompting healthcare systems to consider how best to improve prevention, such as earlier primary care health checks. We assessed potential barriers to the success of the current proposal in England to reduce the starting age of the 5-yearly NHS health check from 40 to 30 years.

In a prospective population-based study (Oxford Vascular Study; 1/4/2002–31/3/23) of 94 567 people in a subpopulation of Oxfordshire, UK, we assessed all participants with incident acute vascular events occurring at age 30–44 years and determined the proportion of those who would have qualified for active risk management were they to have had the proposed new health check prior to their event (i.e. premorbid QRISK3-10-year absolute CV-risk ≥ 10%). We also assessed CV-risk relative to age-specific ‘ideal’ risk (QRISK3-Relative Risk (RR) score, predicted “healthy-heart-age”) and number of risk factors above recommended target.

During 433,797 person-years of ascertainment, 217 individuals aged 30–44 years had an incident vascular event (crude incidence rate 50/100 000 person years). Of these, 155 would have been eligible for an earlier health check. The median 10-year predicted CV risk in this group was only 2.5% (IQR = 1.1–4.8%), with 148 (95%) falling below the 10% threshold for active risk management. The median 10-year risk among the 49 women was 1.1% (IQR 0.5–2.2%), with none having a predicted risk above the 10% threshold. Yet, the mean predicted “healthy heart age” gap was 9 years(SD = 7), and 137(88%) had at least one treatable risk factor above target level.

The majority of vascular events at age 30–44 years occur in individuals with treatable risk factors above target level, yet the vast majority had falsely reassuring premorbid 10-year CV risks that were well below the 10% threshold for treatment, potentially undermining the effectiveness of earlier primary care health checks.

The online version contains supplementary material available at 10.1186/s12916-026-04657-7.