EXAMPLE · MADE BY HEA’S OWN RULES
A real check-up plan, for a fictional person
This is the plan Hea gives at the end of a check-up in Claude or ChatGPT. It was made by Hea’s rules from Sam’s answers below, the same way as yours would be. Sam is not a real person. Every line says in plain words why it matters, and which guidance it rests on.
What Sam told Hea
- Age 44, male, white
- 178 cm, 92 kg
- Never smoked
- 14 units of alcohol a week
- 60 minutes of moderate activity a week
- No diabetes, high blood pressure or heart disease
- Father: heart attack at 52
- Mother: coeliac disease
- Fewer than 20 moles
- No NHS Health Check yet
Blood and urine tests to do now
Cholesterol panel (lipids)
Cholesterol is one of the main numbers in the 10-year heart attack and stroke risk score. Knowing that risk early gives time to lower it with lifestyle or treatment.
Due at your age
Every 5 years. Already part of the NHS Health Check if you have had one recently.
Based on: NICE NG238 (heart and stroke risk)
Also: NHS Health Check best practice 2019 · MHLW Tokutei Kenshin · KR NHIS
HbA1c (average blood sugar)
HbA1c shows average blood sugar over 2–3 months, picking up type 2 diabetes or the stage just before it. Caught at that stage, lifestyle programmes can lower the chance of diabetes.
BMI: 29 kg/m²
Every 3 years if normal; yearly if borderline.
Based on: NICE PH38 (preventing type 2 diabetes)
Also: USPSTF 2021 (PMID 34427594) · ADA Standards of Care 2026 (PMID 41358893) · MHLW Tokutei Kenshin 2024 · KDA 2025 (PMID 40631460)
Coeliac blood test (tTG-IgA and total IgA)
This test looks for coeliac disease, an immune reaction to gluten that harms the gut. It is more common in close family and with type 1 diabetes or autoimmune thyroid disease.
Coeliac disease in close family
Once. Keep eating gluten daily for 6 weeks before the test.
Based on: NICE NG20 (coeliac disease)
Measure yourself
Blood pressure
Blood pressure is one of the main inputs to heart attack and stroke risk. A raised reading is checked again at home, and high blood pressure can be brought down.
Due at your age
Yearly. If it is 130–139/80–89, measure at home for 1–3 months.
Based on: NICE NG136 (high blood pressure)
Also: USPSTF 2021 · MHLW Tokutei Kenshin · KR NHIS
Waist-to-height ratio
Waist size compared with height reflects the risk of heart disease and type 2 diabetes better than BMI (weight for height) alone. A tape measure is all it takes.
Due at your age
Measure it yourself at each check-up; 0.5–0.59 is raised, 0.6 or more is high.
Based on: NICE NG246 (overweight and obesity)
Also: MHLW Tokutei Kenshin · KR NHIS
Look at your own skin
Knowing your own skin makes it easier to notice a spot that changes or looks different from the rest. Melanoma, a skin cancer, is far more treatable when found early.
Due at your age
What matters is change: a spot that is growing, changing shape or colour, itching, bleeding or crusting, or one that simply looks different from your others.
Sources: NHS.uk, Moles (2026) · Cancer Research UK, Spotting skin cancer · USPSTF 2023 skin cancer screening (I statement)
Lifestyle
Alcohol
Counting weekly units shows how drinking compares with the UK low-risk guideline of 14 units a week. Even brief advice helps many people drink less.
Alcohol, UK units per week: 14 units/week
Based on: NICE PH24 (preventing alcohol harm)
Also: USPSTF 2018 · UK CMO low-risk drinking guidelines 2016
Smoking
Smoking raises heart risk and decides who is offered lung screening. Stopping is the single biggest health improvement, and free NHS Stop Smoking Services more than double the chance of success.
Smoking: Never smoked
Based on: NICE NG209 (smoking and quitting)
Also: USPSTF 2021
Physical activity
Activity is compared with the UK guideline: 150 minutes of moderate activity a week plus strength exercises on 2 days. Low activity adds to the risk of type 2 diabetes.
Moderate activity, minutes per week: 60 min/week
Based on: NICE PH44 (advice on physical activity)
Also: UK CMO physical activity guidelines 2019
Free on the NHS
NHS Health Check (free, every 5 years at 40–74)
One free NHS visit checks blood pressure and cholesterol and works out the 10-year chance of a heart attack or stroke. Spotting the risk early gives time to lower it.
Due at your age
Free every 5 years. Ask your GP practice or a local pharmacy if you have not been invited.
Based on: NICE NG238 (heart and stroke risk)
Also: NHS Health Check best practice 2019
Could discuss (options, off by default)
Not in the plan unless you and your GP decide they help.
Lipoprotein(a), once in a lifetime
Lipoprotein(a), a type of cholesterol particle, helps predict heart attack and stroke risk and needs measuring only once. Acting on the result has no proven benefit yet, so it is optional.
Sources: HEART UK consensus 2019 (PMID 31704552) · ACC/AHA dyslipidaemia 2026 (PMID 41824590) · ESC/EAS 2025 (PMID 40878289)
High-sensitivity CRP
High-sensitivity CRP reflects low-level inflammation in the body. It helps only when heart risk is borderline and the treatment decision is unclear; otherwise the evidence is weak.
Sources: USPSTF non-traditional risk factors 2018 (PMID 29998297) · ESC/EAS 2025 (PMID 40878289)
Kidney function (eGFR) without risk factors
eGFR shows how well the kidneys filter blood. Without diabetes, high blood pressure or heart disease, UK guidance does not advise testing, though it may be worth discussing from 55.
Based on: NICE NG203 (chronic kidney disease)
Also: KR NHIS
HIV test, once
A one-off test can find HIV, which can be treated once known. Some countries test every adult once; the UK goes by local rates and risk.
Free and confidential at NHS sexual health clinics.
Based on: NICE NG60 (HIV testing)
Also: USPSTF 2019
Hepatitis B test, once
Hepatitis B is a virus that can damage the liver over years. It is uncommon in the UK without risk factors, so a one-off test is optional rather than routine.
Sources: UKHSA 2025 · USPSTF 2020
Hepatitis C test, once
Hepatitis C is a virus that can damage the liver over years. A one-off test can find it, and then a specialist team takes over the follow-up.
Sources: USPSTF 2020 · UKHSA 2025
Short mood questionnaire (PHQ-2)
Two short questions about low mood and loss of interest can flag possible depression, which can be treated. The UK does not screen everyone, so it is optional.
Sources: UK NSC depression screening · USPSTF 2023
Why these are not in the plan
Tests people are often sold that the guidance does not advise for Sam.
Thyroid test (TSH) for everyone
Without symptoms or an autoimmune condition, a thyroid test mostly finds mild changes, and trials show treating them does not help. So UK guidance does not advise testing everyone.
No national programme tests the thyroid without symptoms; treating mild findings does not help (RCTs).
Sources: UK NSC thyroid disease · USPSTF 2015 · TRUST trial 2017 (PMID 28402245)
Vitamin D test
Without bone or muscle symptoms, a vitamin D result rarely changes anything, since UK autumn and winter advice is the same for everyone. So it is not a routine test.
The UK advises a daily 10 microgram supplement in autumn and winter instead of testing.
Sources: Endocrine Society 2024 · USPSTF 2021
Testosterone without symptoms
Testosterone changes with time of day, food, sleep and illness, so a low number without symptoms is not a diagnosis. Testing men without symptoms often leads to unnecessary treatment.
A low number without symptoms is not a diagnosis and often leads to unnecessary treatment.
Sources: Endocrine Society 2018 (PMID 29562364) · EAU 2026
Tumour marker panels (CEA, CA 19-9, CA-125…)
Tumour markers miss most early cancers and raise false alarms that lead to worry and more tests. No guideline uses them to check people without symptoms.
They miss most early cancers and raise false alarms.
Based on: NICE NG12 (spotting possible cancer)
Also: USPSTF 2018
Homocysteine
Homocysteine has been linked to heart disease, but in trials lowering it did not reduce heart attacks or strokes. A result would not change what helps, so it is not advised.
Lowering it with vitamins did not prevent heart attacks or strokes in trials.
Sources: USPSTF 2009 (PMID 19805770) · ESC 2021 (PMID 34458905)
'Well man' or 'well woman' hormone panels
Hormone levels change through the day and the monthly cycle, so results without symptoms are hard to read. Bundling many hormones together multiplies false alarms.
Hormones vary by the hour and cycle; results without symptoms are hard to interpret.
Based on: NICE NG23 (menopause) · NICE NG257 (fertility problems)
Fasting insulin or HOMA-IR
Fasting insulin tests are not standardised (laboratories measure it differently), and no guideline uses them for screening. HbA1c answers the useful question about diabetes risk.
Not standardised; HbA1c answers the useful question.
Sources: ADA/AACC laboratory guideline 2023 (PMID 37471273)
B12 and folate without risk factors
Low B12 can cause anaemia and nerve problems, but without symptoms and a risk factor such as a vegan diet or some medicines, testing rarely helps. Age alone is no reason.
Tested when there are symptoms plus a risk factor such as metformin or a vegan diet (NICE NG239).
Based on: NICE NG239 (vitamin B12 deficiency)
Apps that judge a mole from a photo
Studies found these apps miss melanomas, and a missed one is worse than no app because it falsely reassures. A changing mole needs a GP, not an app.
Studies of these apps found they miss melanomas; a missed one is worse than no app. Hea keeps and dates your photos but never judges them.
Sources: Freeman et al., BMJ 2020;368:m127 (PMID 32041693)
Resting ECG without symptoms
In people without symptoms, a resting ECG (heart tracing) adds nothing to a heart risk score and often leads to further tests. So it is not advised as a check-up test.
Does not improve on risk scores and leads to more tests.
Sources: USPSTF 2018
Liver ultrasound without symptoms
What matters for the liver is scarring, and an ultrasound shows fat but not scarring. A blood score (FIB-4) is the better first step, with a scan only if needed.
Shows fat but not scarring; a blood score is the better first step.
Sources: AASLD 2023 · EASL-EASD-EASO 2024
Thyroid ultrasound without symptoms
Thyroid ultrasound often finds harmless lumps (nodules), leading to diagnoses of cancers that would never have caused harm. Where it became widespread, diagnoses rose but deaths did not change.
Finds harmless nodules and leads to overdiagnosis of thyroid cancer.
Sources: USPSTF 2017 (PMID 28492905)
Next check-up: in 12 months.