Test, Don’t Guess: Why Your 40s Are the Decade to Check Cholesterol, Liver, and Fitness

You can feel well at 45 and still have a good reason to book a health check. Feeling well tells you something valuable about your day. It tells you much less about your cholesterol.

That is what makes England’s pharmacy cholesterol programme interesting. It puts prevention somewhere you already go, without requiring you to feel ill first.

Your forties are a sensible time to take stock of cardiovascular risk, liver health and fitness. The useful question is simple: what should you measure now, and what would you do with the result?

Seven minutes, with a follow-up attached

On 31 August 2026, NHS England announced plans for seven-minute cholesterol checks at around 100 pharmacies from autumn. Eligibility covers people aged 40 to 84 who are not pregnant and have not had a blood test in the previous year. The consultation also offers a blood pressure check and advice from a pharmacist prescriber.

The announcement needs one qualification. An update on 11 September clarified that this is a Barts-led programme, running until spring 2027, rather than a nationally commissioned service available everywhere. Check local participation before making the trip. NHS England, 2026.

The preceding London pilot gives a concrete picture of what accessible testing can find:

| Pilot measure | Reported result | | — | — | | People tested, January 2025 to March 2026 | 2,493 | | Participating community pharmacies | 61 | | Participants considered suitable for medication | 19% | | People started on statins | 88 |

These figures describe detection and treatment activity. They do not establish how many heart attacks the programme prevented. Barts Health NHS Trust, 2026.

The NHS ambition to reduce heart disease and stroke deaths by a quarter over a decade remains a target. For you, the immediate value is more modest and more tangible: an opportunity to identify a risk and discuss what happens next.

What “I feel fine” leaves unanswered

Cholesterol carries a history

The European Atherosclerosis Society’s 2017 consensus reviewed evidence from more than 200 studies involving over two million participants. Its conclusion was clear: LDL causes atherosclerotic cardiovascular disease, and the duration of exposure matters alongside the level.

That makes a cholesterol result more than a verdict on your recent diet. Two people with the same LDL today may have spent very different lengths of time at that level. Earlier assessment gives you more time to address an unfavourable exposure. European Atherosclerosis Society, 2017.

Ask for the actual results and an explanation of what they mean for you. A laboratory reference range cannot conduct that conversation.

A normal liver enzyme result has limits

A 2023 review in Hepatology, covering more than nine million people, estimated a pooled global prevalence of fatty liver disease of about 30%. Those studies used the older NAFLD definition and data from 1990 to 2019; the figure should not be presented as a fresh measurement of today’s population. Younossi and colleagues, 2023.

The more personally useful finding concerns testing. A 2020 meta-analysis found normal ALT levels in approximately 25% of patients with NAFLD, although results varied substantially between studies. That means normal ALT cannot exclude fatty liver. It does not mean that a quarter of people with normal ALT have the disease. Ma and colleagues, *BMC Gastroenterology*, 2020.

Whether you need further assessment depends on your risk. The 2024 EASL, EASD, EASO guidelines recommend looking for liver fibrosis particularly in people with type 2 diabetes, abdominal obesity plus another metabolic risk factor, or abnormal liver tests. They advise against general population screening.

For suitable patients, assessment can start with FIB-4, a blood-based fibrosis score, followed by elastography when indicated. Diet, physical activity and weight management where appropriate are part of treatment. EASL, EASD, EASO, 2024.

Fitness deserves a place in the conversation

In a 2018 Cleveland Clinic study, 122,007 patients who underwent treadmill testing were followed for a median of 8.4 years. Higher cardiorespiratory fitness was associated with lower mortality, including among the highest-performing participants.

This was an observational study of patients referred for testing. It cannot promise that a particular training programme will extend your life by a particular amount. It does give fitness a serious claim on your attention. Mandsager and colleagues, *JAMA Network Open*, 2018.

You do not need to turn every walk into an examination. Start by asking what physical capacity you want to keep: climbing hills, cycling with friends, carrying luggage without needing a pause.

In their August 2026 essay, Nicholas Nelson, Taylor Yeater and Peter Attia frame Zone 2 training around the capacity it helps build. That is a useful coaching perspective: choose training that serves your objective, and give yourself a way to assess progress. Nelson, Yeater and Attia, 2026.

Make the next appointment earn its place

Bring your previous results if you have them. Write down the questions you tend to remember only after leaving.

This small table can serve as an appointment note:

| Area | Question to bring | What to leave with | | — | — | — | | Cholesterol and cardiovascular risk | “How do these results fit my overall risk, and would any additional testing change the plan?” | Your results, an explanation and an agreed action | | Liver health | “Do my risk factors justify fibrosis assessment, even if ALT is normal?” | A decision about whether further assessment is appropriate | | Fitness | “What is a suitable starting point for my current health and activity level?” | A realistic activity plan and a way to review it | | Follow-up | “When should we reassess, and what result would change treatment?” | A date or a clear reason for the chosen interval |

For your own fitness record, you might choose a familiar walk or cycle ride at a comfortable effort. Note the route, duration and how it felt. Treat this as a personal comparison, without assigning it a diagnostic meaning.

The same restraint helps with blood results. Agree on the follow-up interval with your clinician. A universal testing calendar makes little sense when one person is starting treatment and another has reassuring results.

There is no need to invent an alarming fictional patient to make this matter. Your own unanswered questions are enough.

Before the next appointment ends, make sure you can explain the plan in ordinary language: what you are working on, why it matters and when you will review it. That is where a test begins to become useful.

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