The life-saving tests and scans the NHS won’t give you: PROFESSOR ROB GALLOWAY reveals how to access them, what they cost, the age to start and what’s NOT worth your money

As if any of us needed reminding that the UK had one of the worst death rates in the Western world during Covid.

But things have not got much better – a new report published by research charity The Health Foundation makes for depressing reading.

It found that the number of years people in the UK can expect to live in good health has fallen by about two years over the past decade – it is now around 61.

So although many of us are living longer (life expectancy here is about 79 for men and 83 for women), we’re unwell for more of those years.

And for once it’s not the NHS’s fault – it’s largely our own.

Some people don’t like seeing a doctor. I recently saw a patient in A&E who had avoided doctors like the plague. His high blood pressure and high cholesterol went untreated for years, paving the way to a life-changing stroke.

But for most people it’s about doing the basics: exercise more, sleep better, don’t smoke, drink less, eat proper food, avoid ultra-processed rubbish, keep your weight under control, stay socially connected and get vaccinated.

Of course, telling people to ‘be healthier’ is like telling someone to be better with money without showing them their bank balance. What they often need is a proper prevention review.

I don’t mean a gimmick like a private health MoT with a £2,000 scan and a printout of 175 blood tests without explanation. We need a serious attempt to understand our individual risks and treat them before they cause ill health.

Good prevention starts with boring things like checking blood pressure, cholesterol, blood sugar levels, weight, waist size.

You get some of this with the NHS Health Check, which in England is offered every five years to eligible adults aged 40 to 74.

But it’s not a full prevention MoT. As it’s the NHS, it’s based on whether a test is cost-effective for millions. 

We can’t pretend this check and NHS screening programmes such as for breast cancer are all we need in terms of prevention, and here are the additional tests I’d recommend you consider paying for via a longevity clinic. 

I think it is reasonable to do these tests every three to five years from your 40s onwards, unless there is reason to do them earlier.

The deluxe cholesterol tests 

Standard cholesterol tests tell you how much cholesterol is in the blood, including low-density lipoprotein (LDL) or ‘bad’ cholesterol, particles that can get into artery walls and build plaque.

Apolipoprotein B, or ApoB, is a protein found on the surface of the cholesterol-carrying particles most likely to clog arteries. 

Two people can have similar ‘bad’ LDL readings, but one may have many more of these particles travelling through their blood – and therefore a higher risk of heart disease.

That is why ApoB can sometimes give a better sense of risk than a standard cholesterol test alone. As a rough guide, an ApoB level above 1.0g/L suggests higher risk, but the ideal target depends on someone’s overall cardiovascular risk. 

I think it’s worth considering this test from 40 onwards (earlier if you have excess belly fat, type 2 diabetes, obesity, kidney disease or a family history of heart disease) and we should all track these levels every few years.

If ApoB is high, it usually means taking cholesterol reduction more seriously, through diet, weight, exercise and, where appropriate, statins or other cholesterol-lowering treatment.

Lipoprotein(a) is another cholesterol-carrying particle. It can be tested from the same blood test as ApoB, but this only needs to be measured as a one-off because levels are largely genetic.

A level below about 75nmol/L is generally reassuring, while above 125nmol/L is considered high.

If it is high, your cardiovascular risk may be higher than your standard cholesterol suggests, and it may mean treating every other risk factor harder – e.g. treating blood pressure and cholesterol at lower levels than if you had normal lipoprotein(a).

The ‘smart’ blood sugar check

HbA1c should also be on the list of blood tests to track over the years. This is a measure of how much glucose has stuck to haemoglobin in red blood cells.

It shows your average blood sugar over the previous two to three months and is useful to know even if you don’t have type 2 diabetes, because metabolic health is a slope, not a cliff edge.

In the UK, below 42mmol/mol is normal, 42 to 47 is pre-diabetes; and 48 or above is diabetes – but I would want mine comfortably below 42 and not creeping up each year.

Another thing to look at is your levels of insulin after fasting overnight, known as fasting insulin – as these are the first to rise and your HbA1c may still look normal. If elevated, you can improve things with a healthier lifestyle and a reduction in refined carbs and ultra-processed food.

Heart markers you’ve never heard of 

Uric acid and homocysteine both give clues about cardiovascular and metabolic risk, although neither is a magic standalone test.

Uric acid is a normal waste product made when the body breaks down purines, substances found naturally in our cells and in some foods.

It’s best known for its links to gout but a raised level can also be a clue to insulin resistance – where your cells aren’t able to take in the sugar from the blood as efficiently – and poor metabolic health, linked to higher risks of a heart attack or stroke.

A very high level is treatable with gout medications. 

Homocysteine is an amino acid in the blood and high levels are also linked with cardiovascular risk – again, possibly as a result of inflammation.

High sensitivity CRP (C-reactive protein) is another useful test. It’s a broad marker of inflammation and, if persistently raised (it goes up with infections so don’t be alarmed by one-off results), can be a clue to higher cardiovascular and metabolic risk.

All these tests can be done from one blood sample but the value comes from proper interpretation and medical treatment by a specialist in longevity, not just buying a bundle of results and discussing them with ChatGPT.

The safety net test 

As well as the above, every three to five years, I’d recommend a full blood count which can pick up asymptomatic anaemia, which might be due to poor diet, heavy periods or hidden and unexpected blood loss (e.g. from the bowel, particularly in older adults).

To pick up early signs of kidney damage (the standard blood test detects things like creatinine or urea and often picks up problems late), a urine albumin-to-creatinine ratio (ACR) is useful – the test looks for tiny amounts of protein leaking into the urine, which can be signs of abnormal damage before someone feels unwell.

That matters because, in the right person, kidney damage can often be slowed with better blood pressure control.

Liver tests are increasingly relevant as more of us now suffer from fatty liver disease. Untreated, it can progress silently to scarring and, eventually, cirrhosis.

Knowing if your liver enzymes are elevated is the first sign there are problems you must address.

Vital vitamins and hormones 

I would also include a vitamin D blood test in a longevity screen because low levels matter for bone health and muscle function.

For men, testosterone is worth discussing – because genuinely low testosterone can affect libido, erections, mood, muscle, fatigue, fat distribution and bone density.

In women, symptoms such as irregular periods, early menopause, severe menopausal symptoms, low libido or bone-density concerns may justify targeted hormone tests, such as FSH, LH and oestradiol. Again, these results need proper interpretation by an expert.

…and get these scans 

Other useful tests (that you wouldn’t necessarily get from your GP unless you had symptoms) include an ECG. This can pick up atrial fibrillation, a faulty heartbeat that’s a major risk factor for strokes. An ECG every three to five years is a good idea.

A DEXA scan can diagnose osteoporosis and assess body composition – have one perhaps every five to ten years (they emit some radiation so I wouldn’t do it more regularly than that).

VO2 max is another useful measurement – it shows how well your heart, lungs, blood and muscles use oxygen during exercise and is one of the best markers of physical health and one of the best predictors of life expectancy.

Track it every three to six months to help you see the impact of your lifestyle changes.

A coronary artery calcium score can also be useful: This is a low-dose CT scan of the heart looking for calcium in the coronary arteries (like looking for limescale in the pipes). 

A high score means plaque has been building up and prevention needs to be taken more seriously. This scan should be done only every five to ten years because of the small amounts of radiation involved.

The standard NHS screening still matters, e.g. bowel cancer tests you do at home and breast screening, so see these additional tests as an investment in your future: the worst moment to realise you needed prevention is lying on a trolley in A&E because of an illness that started years ago.

By then, medicine can still help. But the window for prevention may have been missed.

@drrobgalloway