Experts Suggest NHS Heart Risk Checks from Age 25

Medscape

06-06-2025

MANCHESTER — Cardiovascular health assessments should begin much earlier, focusing on lifetime risk rather than just their 10-year projections, experts said at the British Cardiovascular Society Annual Conference 2025.
'We are looking at cardiovascular risk assessment far too late', said Beverley Bostock, a Queen's nurse and president-elect of the Primary Care Cardiovascular Society (PCCS).
Bostock was introducing a conference session titled '25 is the new 40: shifting the focus to lifetime risk'.
Prevention Focus in NHS Strategy
Derek Connolly, a consultant cardiologist in private practice in Birmingham, said he hoped this approach would be supported in England's 10 Year Health Plan for the NHS.
'There is going to be an enormous emphasis, we think, going forward, on preventive cardiology – and it's about time that that was the case', he said.
Connolly said that the team behind the plan were 'very into prevention' and 'had done the math' on the potential benefits of well-known strategies such as lifestyle interventions.
By addressing modifiable risk factors earlier and throughout the life course, 'they've worked out that if we do a lot of these things, not only do we save lives, but we save money, and we keep people in work and paying taxes', he said.
Rising CVD Burden
Recent data in the European Journal of Preventative Cardiology , highlighted during the session, projected a 90% increase in global cardiovascular disease (CVD) prevalence over the next 25 years.
CVD-related deaths are expected to rise from 20.5 million in 2025 to 35.6 million in 2050 – a 73.4% increase in crude mortality.
Current NHS Risk Assessments
The NHS currently assesses 10-year CVD risk from age 40, repeating every 5 years until age 74. This is typically measured using the cardiovascular risk score (QRISK 2), embedded in GP consulting software, although QRISK 3 and QRISK lifetime offer greater predictive power.
Jim Moore
"CVD risk is predicated around a lifetime exposure to risk factors,' said Jim Moore, a recently retired GP with a special interest in cardiovascular medicine. 'Just modest changes in those risk factors — your lipid profile or blood pressure — can, we know independently, and in combination, improve your outcomes.'
 Moore, a past president of the PCCS, said 10-year calculators may underestimate risk in those under 40, even when significant risk factors are present. Lifetime calculators could be 'persuasive' tools in patient consultations, he argued, with results helping to steer discussions towards lifestyle changes and risk factor modifications.
The key message, he said, was the need for a holistic approach, which was 'something that we really do not see routinely happening in my area within primary care'.
Case for Earlier Screening
Scott Murray, a consultant cardiologist at University Hospitals of Liverpool Group and former president of the British Association for Cardiovascular Prevention and Rehabilitation, made the case for assessing CV risk in people under 40.
Scott Murray
Modern lifestyles characterised by sedentary behaviour, poor dietary habits, and increasing stress were contributing to rising CVD in younger populations. 'We're seeing more obesity, insulin resistance, dyslipidaemia, and hypertension', Murray said.
'I like to think of it a bit like this: so, you've got your genetic predisposition – genetics loads the gun, and your environment pulls the trigger.'
Murray proposed age 25 as a theoretical "sweet spot" for screening. 'There's a sort of lifestyle transition at age 25 into more independent adulthood, more able to potentially think about family responsibilities.'
At age 25, most people have finished puberty and reached physiological maturity. Data suggests that starting CVD screening at this age would be cost-effective by maximising opportunities for lower-cost interventions, according to Murray.
However, he acknowledged potential difficulties in engaging 25-year-olds when NHS health checks for over-40s have not reached hoped-for targets.
Targeted Approach
Laura Ormesher, a National Institute for Health and Care Research academic clinical lecturer at the University of Manchester, suggested that pregnancy could be an ideal time to educate younger women about lifestyle-related CVD risk.
'We know that adverse pregnancy outcomes increase the risk of cardiovascular disease, and I think we've got to make the most of that opportunity during the pregnancy,' she said.
She added that the postnatal period — typically 'a little bit less complicated for women' — is a time when many felt 'empowered to try and improve their long-term health for their child and their family,' Ormesher added.
Dr Sundhya Raman
Dr Sundhya Raman, a lifestyle physician, acknowledged that universal health checks from age 25 might be too ambitious but supported a targeted strategy.
'Maybe we need to target the higher risk individuals with strong family histories of raised BMI,' she said.
'There is great potential for when you educate one person, you educate a family, you educate a community,' Raman added.
Moore has received honoraria for participation in educational activities and advisory boards from AstraZeneca, Amarin, Boehringer Ingelheim, Eli Lilly and Company, Daiichi-Sankyo, Novartis and Medtronic. Raman acknowledged she was a founder of My Wellness Doctor and My Weight Loss Doctor Clinic . Murray declared being the founder and medical director for Venturi Cardiology but had no relevant conflicts of interest. Ormesher had no conflicts to declare.