Heart Health Checks

A practical check to understand and reduce your risk of heart attack and stroke

You can feel perfectly well while high blood pressure, high cholesterol, diabetes or smoking quietly increase your risk of heart attack and stroke.

That is why heart health cannot be judged by symptoms alone.

A Heart Health Check brings the important risk factors together. Rather than looking at one number in isolation, your GP estimates your overall cardiovascular risk and works with you on a plan to reduce it.

The purpose is not to predict exactly what will happen. It is to identify risks early enough to do something useful about them.

What is a Heart Health Check?

A Heart Health Check is a comprehensive assessment of your risk of cardiovascular disease, particularly heart attack and stroke.

It generally takes at least 20 minutes and is intended for people who do not already have diagnosed cardiovascular disease. During the appointment, your GP or practice nurse gathers information, checks relevant measurements and uses the Australian cardiovascular disease risk calculator to estimate your risk over the next five years.

The result is placed into one of three broad categories:

• Low risk: less than 5% chance over five years
• Intermediate risk: 5% to less than 10%
• High risk: 10% or greater

These percentages do not guarantee an outcome. They help guide decisions about lifestyle changes, follow-up, medication and whether any additional assessment may be useful.

Who should have one?

Under the current Australian cardiovascular risk guideline, formal risk assessment is recommended for people without known cardiovascular disease who are:

• Aged 45–79 years
• Aged 35–79 years and living with diabetes
• First Nations people aged 30–79 years

For First Nations people aged 18–29 years, individual cardiovascular risk factors should still be assessed even though the full calculator is generally used from age 30.

You may need cardiovascular assessment earlier if you have concerning symptoms, a strong family history or significant risk factors. This may not be the same as a routine Heart Health Check.

What happens during the appointment?

Your GP or nurse will usually discuss several parts of your health rather than relying on a single test.

Your health history
You may be asked about smoking, diabetes, current medicines, previous health problems, family history of premature heart disease or stroke, physical activity, eating habits, alcohol, ethnic background, mental health and pregnancy-related conditions such as pre-eclampsia or gestational diabetes.

Some of these factors are included directly in the calculator. Others help your GP interpret the result more accurately.

Blood pressure
High blood pressure often causes no symptoms.

Your blood pressure may be measured more than once, especially if the initial reading is raised. Your GP may recommend home monitoring or a 24-hour blood-pressure monitor if the result is uncertain or appears different from your usual readings.

One high reading does not always mean you have ongoing hypertension. Persistent elevation still deserves proper assessment.

Cholesterol
A blood test usually measures total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides.

The Australian cardiovascular risk calculator uses the ratio of total cholesterol to HDL cholesterol. Your GP will also consider the individual results and your overall clinical picture.

Diabetes and kidney health
Blood glucose or HbA1c may be checked if diabetes is present, suspected or overdue for review.

For people with diabetes, the calculator can incorporate additional information such as HbA1c, how long diabetes has been present, kidney function, urinary albumin, body mass index and insulin treatment.

Kidney disease can significantly increase cardiovascular risk. Depending on your situation, your GP may arrange blood and urine tests to assess kidney function.

Why individual risk factors are not enough

A mildly raised cholesterol result may have different implications in a healthy non-smoker aged 46 than in someone aged 70 with diabetes, high blood pressure and a strong family history.

Likewise, a person can have several modest abnormalities that combine to create substantial risk.

This is called absolute cardiovascular risk. It considers how your risk factors interact rather than treating each one separately.

That broader view helps avoid two common problems:

• Under-treating someone whose overall risk is high
• Over-treating one isolated number in someone whose overall risk is low

The calculation supports clinical judgement. It does not replace it.

Factors that may change how your result is interpreted

Some circumstances can make a calculated result less straightforward.

The Australian guideline highlights factors including ethnicity, family history of premature cardiovascular disease, chronic kidney disease, severe mental illness and coronary artery calcium scoring.

These may lead your GP to reconsider whether your estimated risk category fully reflects your true risk.

Certain people are already considered at high risk because of conditions such as moderate-to-severe chronic kidney disease or familial hypercholesterolaemia. In those situations, management may not depend on the calculator.

Will I need an ECG or heart scan?

Not routinely.

A Heart Health Check is mainly a risk assessment. It is not automatically an ECG, stress test, echocardiogram or CT scan.

These tests may be appropriate when symptoms, examination findings or other clinical concerns suggest a separate problem.

A coronary artery calcium score uses a CT scan to measure calcified plaque in the heart’s arteries. It may sometimes help refine risk after a Heart Health Check, particularly when the best management approach remains uncertain. It is not required for everyone.

What happens after the risk is calculated?

The most important part of the check is the plan that follows.

Depending on your results, this may include stopping smoking, becoming more physically active, improving eating habits, working towards a healthier weight, reducing harmful alcohol use, managing blood pressure, managing cholesterol, improving diabetes control, reviewing medicines, referral to another health professional, or repeat testing and follow-up.

The Australian guideline includes both healthy lifestyle support and, where appropriate, blood-pressure-lowering or lipid-modifying medicines as part of cardiovascular risk management.

A higher risk result does not mean a heart attack or stroke is inevitable. It means the potential benefit of reducing risk is likely to be greater.

Know the warning signs

A routine Heart Health Check is for prevention. It is not the right appointment for urgent symptoms.

Call 000 if you develop symptoms that could indicate a heart attack or stroke, including chest pressure, tightness or severe discomfort; sudden shortness of breath; collapse or fainting; sudden facial weakness; sudden weakness or numbness on one side; or sudden difficulty speaking or understanding speech.

Do not wait for a routine appointment when symptoms are severe, sudden or concerning.

Start with one change

A useful first step may simply be to check whether you are due for a Heart Health Check.

You could also book a GP appointment, find out your latest blood pressure, arrange an overdue cholesterol test, stop smoking with professional support, walk for ten minutes most days, or take prescribed medicines consistently.

The check provides information. Repeated actions are what reduce risk over time.

The bottom line

A Heart Health Check helps estimate your chance of having a heart attack, stroke or other cardiovascular event over the next five years.

It brings together your age, blood pressure, cholesterol, smoking, diabetes, medicines and other relevant health factors. Your GP can then help you understand what the result means and which actions are most likely to benefit you.

You do not need to wait until you feel unwell. Cardiovascular prevention works best when risk is identified early and managed consistently.