Methodology

How the score works

Your score is a number from 0 to 100. Eighty points come from eight measures of heart and metabolic health; twenty come from the screenings and shots recommended for your age and sex. It’s built on the American Heart Association’s Life’s Essential 8, a published, peer-reviewed scoring system that predicts heart disease, stroke and other outcomes in large studies. We use its eight factors, its cut points and its bands. Where its point tables use wide steps (any BMI under 25, or any activity over 150 minutes, scores a full 100), we use graded scales anchored on the same cut points, so your score keeps responding where the evidence says risk keeps changing. A perfect 100 is meant to be hard to reach.

The score is information, not a diagnosis, and it doesn’t replace your clinician. Checkup Score is independent and isn’t affiliated with or endorsed by the American Heart Association or the USPSTF.

The eight factors

Your score has two parts. 80 points come from health and habits: the eight factors below, each scored 0 to 100 on a scale that moves smoothly between the points shown, then averaged. 20 points come from prevention: the screenings, vaccines and checkups recommended for you. So a 100 means both are in great shape.

Blood pressureYour home average once you have readings on 3 days (a full week is best); until then, the reading you told us. Scored on whichever number, top or bottom, is less healthy.Top number: 110 or lower: 100 · 120: 90 · 130: 70 · 140: 45 · 160: 15 · 180: 0. Bottom number: 70 or lower: 100 · 80: 80 · 90: 45 · 100: 15 · 110: 0. Minus 20 if on blood pressure medicine.

CholesterolNon-HDL, LDL and ApoB from your latest labs, each on its own scale. We score the least healthy of the three, so a normal non-HDL can’t hide a high LDL or ApoB.Non-HDL 100 or lower: 100 · 130: 85 · 160: 60 · 190: 35 · 220: 15 · 250: 0. LDL 70: 100 · 100: 85 · 130: 60 · 160: 35 · 190: 15. ApoB 70: 100 · 90: 85 · 110: 60 · 130: 35 · 150: 15. Minus 20 if on cholesterol medicine.

Blood sugarA1c from your latest labs, or a glucose labeled fasting.A1c 5.3 or lower: 100 · 5.6: 90 · 5.7: 80 · 6.0: 70 · 6.4: 60. Fasting glucose 90 or lower: 100 · 99: 90 · 100: 80 · 125: 60. In the diabetes range (A1c 6.5+, diagnosed or not), the AHA’s diabetes scale: under 7: 40 · 7–7.9: 30 · 8–8.9: 20 · 9–9.9: 10 · 10+: 0.

WeightBody mass index from your height and latest weight. If you add your waist size, we score your waist-to-height ratio instead, since BMI can’t tell muscle from fat (NICE 2022).BMI 19.5 to 21.5: 100 · 23: 92 · 25: 80 · 27.5: 65 · 30: 50 · 35: 25 · 40: 8. Under 18.5 also scores lower (17: 55). Waist-to-height 0.45 or lower: 100 · 0.5: 85 · 0.55: 65 · 0.6: 40 · 0.65: 20.

ActivityMinutes a week of moderate or vigorous activity, like a brisk walk or a bike ride. Vigorous minutes, like running, count twice, as in the Physical Activity Guidelines for Americans. From a connected ring, band or watch when you have one, over the last two weeks.450 or more: 100 · 300: 94 · 150 (the guideline): 80 · 120: 70 · 90: 60 · 60: 45 · 30: 25 · none: 0. Benefits keep growing up to about three times the guideline.

SleepHours on a typical night. Devices count only time asleep, which runs shorter than what people report, so we add 30 minutes to device sleep before scoring it.7 to under 9: 100 · 9 to under 10: 90 · 10 or more: 40 · 6½: 85 · 6: 70 · 5: 40 · 4: 15.

NicotineCigarettes, vapes and other inhaled nicotine.Never: 100 · quit 5+ years: 75 · quit 1–5 years: 50 · quit within a year: 25 · current: 0. Minus 20 if someone smokes indoors at home.

DietAn 8-question check-in based on the Mediterranean eating pattern questionnaire used by Life’s Essential 8.12.5 points for each healthy habit: all 8 is 100, 6 is 75, 4 is 50.

What the score means

80–100

Strong

50–79

Room to improve

0–49

Needs attention

These match the AHA’s categories of high (80+), moderate (50–79) and low (under 50) cardiovascular health.

How we keep it honest

We only count what we can measure. Missing factors are left out, not counted as zero, and you always see how many of the eight are in. A score needs at least three.
Preliminary until there are labs. Habits alone can’t confirm a score, so it’s marked preliminary until you add a cholesterol or blood sugar result.
Accuracy. Low, Fair, Good or High, based on how many factors are measured rather than estimated, whether there are labs, and how recent they are.
Latest results count. We always use your newest labs. Results over three years old still count but are marked out of date, matching common retesting intervals.
Blood pressure is averaged. One reading can be off by 10 points, so once you’ve logged readings on seven different days, the score uses their average.
Treatment counts honestly. As in Life’s Essential 8, a number reached with medicine scores 20 points lower than the same number without it, and diabetes uses its own scale. Good control on treatment is still rewarded.

Who reviews the method

Physician review of the method is under way. When it’s done, each reviewer will be named here with their credentials, the version they reviewed, the date, and any relationship to the company. Until then, every point traces to the published guideline cited next to it, and the full method is versioned (now 2026.7).

Prevention: 20 points

Staying current on screenings and vaccines is part of being healthy, so it’s part of the score. Only what’s recommended for you counts, so you’re never marked down for a screening you’re too young for, and your own history adds what applies to you: a scan that comes with a gene change, earlier colon screening when a parent had colon cancer, the checks that come with diabetes. Each item is weighted by the strength of the evidence behind it, and your 20 points are shared across your own list. No single item is worth more than 5 of the 20, however short the list:

Cancer screeningsColon, breast, cervical, and lung if eligibleWeight 3

VaccinesFlu each season, tetanus, shingles, pneumonia, RSVWeight 2

Bone density scanWomen 65 and olderWeight 2

One-time testsHepatitis C, HIV, aortic aneurysm ultrasoundWeight 1

Yearly checkupWhere most of the rest gets doneWeight 1

Mood and alcohol checksShort yearly questionnaires taken privately in the app. Taking them counts; the answers never doWeight 1 each

With diabetesA1c twice a year; yearly eye, foot and kidney checks (ADA)Weight 2 each

From family historyA genetic risk assessment when the family signs are strong (USPSTF, NCCN)Weight 3

From a genetic testThe repeating scan that comes with a confirmed gene change, such as a breast MRI for BRCA (NCCN, GeneReviews)Weight 3

Example: a 52-year-old woman due for colon, breast and cervical screening, flu, shingles and tetanus shots, a yearly checkup, and the mood and alcohol checks has 18 weight in all. If only her flu shot is missing, she has 16/18 of 20 = 17.8 prevention points, shown as 18, and the flu shot is worth about 2 points. We show whole numbers; the score itself is worked out before rounding. Points come from getting it done, wherever you get it. Items you haven’t told us about count as not done until you do.

We follow U.S. Preventive Services Task Force recommendations (grades A and B) by age, sex and history, and the CDC adult vaccine schedule:

Colon cancer screeningAges 45 to 75 (USPSTF 2021)

MammogramWomen 40 to 74, every 2 years (USPSTF 2024)

Cervical cancer screeningWomen 21 to 65 (USPSTF 2018)

Lung cancer screening50 to 80, with 20 pack-years of smoking (USPSTF 2021)

Bone density scanWomen 65 and older (USPSTF 2025)

Aortic aneurysm ultrasound, onceMen 65 to 75 who ever smoked (USPSTF 2019)

Hepatitis C test, onceAdults 18 to 79 (USPSTF 2020)

HIV test, onceAges 15 to 65 (USPSTF 2019)

Flu shotEvery fall (CDC)

Tetanus boosterEvery 10 years (CDC)

Shingles and pneumonia vaccinesFrom 50 (CDC)

RSV vaccine75 and older, or 60+ with heart or lung disease, diabetes or kidney disease (CDC)

Checks your doctor has you onFor example a yearly MRI for a genetic condition

To talk through with your doctorPSA testing from 55 to 69 (USPSTF grade C), and lung screening when smoking history is unclear. Shown as next steps, not counted.

For kids

Kids don’t get a score. Life’s Essential 8 is built for adults, so for anyone under 18 we track what’s due instead:

Checkups on the AAP Bright Futures schedule: well-child visits at 1, 2, 4, 6, 9, 12, 15, 18, 24 and 30 months, then yearly, with anxiety screening from 8 and depression screening from 12 (USPSTF).
Shots on the American Academy of Pediatrics 2026 immunization schedule, round by round from birth to 16, plus a yearly flu shot from 6 months and RSV protection for babies in their first season. In January 2026 the CDC moved several childhood vaccines to shared decision-making with a clinician; the AAP continues to recommend them for all children, and we follow the AAP. Parents should always confirm with their pediatrician.
Growth as BMI-for-age percentile on the CDC growth charts (ages 2 to 19), with the CDC’s 2022 extended percentiles above the 95th. Below the 5th or at the 95th and above, we suggest a conversation with the pediatrician, never a diet.
Dental visits every 6 months from age 1 (AAPD), and cholesterol checks at 9 to 11 and 17 to 21, or from 2 with a family history (AAP/NHLBI).
Teens get a note that part of each checkup is private with the doctor, and at 18 a parent can move the profile to the young adult’s own account.

Keeping it current

Answers about habits go stale. Every couple of weeks we send one quick check-in question by email, or by text if you choose: this week’s weight, a blood pressure reading, or how your habits went. Habit answers count through a rolling 4-week view, so one week doesn’t swing the score. Every 3 months we ask you to confirm your habits, and once a year to review conditions, medicines and family history. Screenings and vaccines that repeat (a mammogram every 2 years, a tetanus booster every 10) come due again based on when you last had them; a rough estimate is fine. Lab results over three years old are marked out of date. Connected devices keep those numbers current on their own: Oura, Whoop, Fitbit and Pixel Watch for activity and sleep, Withings scales and blood pressure cuffs for weight and blood pressure. We re-check every day using your last two weeks, so the score follows what you actually do: exercise more and it goes up, stop for a few weeks and it comes down.

Where your next steps come from

Every next step shows its source. They come from published guidelines: the AHA/ACC blood pressure and cholesterol guidelines, the American Diabetes Association’s Standards of Care, USPSTF screening recommendations, the National Lipid Association, NCCN and USPSTF guidance on inherited cancer risk, AAP Bright Futures and the AAP immunization schedule for kids, CDC growth charts, and CDC flu vaccine recommendations. Your answers and results decide which ones apply to you.

Limits worth knowing

Life’s Essential 8 was built to measure heart and metabolic health. It doesn’t cover everything. Mental health and drinking are never scored: taking the yearly checks earns prevention points, but no answer can lower the score.
BMI is a rough measure and can overstate weight for very muscular people. Adding your waist size corrects for that.
The graded scales are our own, built on the AHA’s cut points and the research behind them: blood pressure risk rises steadily from about 115/75 (Lewington, Lancet 2002), mortality is lowest at a BMI of about 20 to 25 with diabetes risk rising from about 22 (Global BMI Mortality Collaboration, Lancet 2016), activity benefits keep growing to about three times the guideline (2018 Physical Activity Guidelines), and lower LDL and ApoB keep lowering risk.
Habits like sleep and activity are self-reported until you connect a device. If a connected device stops sending data for three weeks, we mark those numbers out of date. Whoop reports workouts rather than all-day movement, so its activity counts workouts only.
The diet check-in is a short version of the questionnaire used in research.

References

Lloyd-Jones DM, et al. Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health. Circulation. 2022.
U.S. Preventive Services Task Force recommendations: colorectal cancer (2021), breast cancer (2024), cervical cancer (2018), depression and anxiety screening.
American Diabetes Association. Standards of Care in Diabetes.
American Academy of Pediatrics. Recommended Child and Adolescent Immunization Schedule, 2026; Bright Futures periodicity schedule.
CDC 2000 growth charts, BMI-for-age; CDC extended BMI-for-age percentiles (2022). Hampl SE, et al. AAP Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023.
2018 AHA/ACC Guideline on the Management of Blood Cholesterol; AHA/ACC high blood pressure guideline.

The method is versioned and updated as the evidence changes. See every update and what changed.

Questions about the method? Email hello@checkupscore.com. We’d love feedback, especially from clinicians.