Only one in five patients eligible for a free "midlife MOT" on the NHS took up the offer in the first four years of the programme.
The NHS Health Check was launched in 2009, aiming to identify people at high risk of cardiovascular disease and offer them preventative treatment.
Independent research commissioned by the Department of Health to evaluate the programme has found that only 21 per cent of those eligible saw their GP or another professional to take part.
The researchers, from Imperial College London, say more work should be done to improve the coverage of the programme and extend the evaluation.
The Health Checks target people aged 40-74 who do not have a pre-existing medical condition. Patients are given a cardiovascular risk score based on information such as their blood pressure, body mass index and cholesterol. Based on their risk level, they might be given lifestyle advice to lower their risk, and some might be prescribed statins or other drugs.
The study found that only one in three patients judged to have a high risk of cardiovascular disease - 20 per cent or more over 10 years - were prescribed a statin after their check-up, as recommended by the National Institute for Health and Care Excellence (NICE). The most recent NICE guidelines say up to 8,000 lives could be saved every three years by offering a statin to anyone with a 10 per cent risk of developing cardiovascular disease within a decade. The findings of this evaluation suggest that extending statin use to lower-risk patients will be difficult.
There were wide variations in the programme's coverage between regions, ranging from 9.4 per cent in Yorkshire and Humber to 30.7 per cent in the northeast. There were also variations between ethnic groups, with lower coverage among black and Chinese patients than white British patients. The research did not find an association between coverage of the programme and socioeconomic status or gender.
Kiara Chang from the School of Public Health at Imperial College London, who led the study, said:
The results show that the Health Check programme has achieved a much lower level of coverage than hoped in the first four years. They also show that statins are only prescribed to a third of patients for whom NICE guidelines recommend them.
For the programme to be successful at preventing cardiovascular disease, more work needs to be done to make it more acceptable to patients and health professionals, and make sure it reaches people who would benefit.
The research was based on a nationally-representative sample of 95,571 patients eligible for Health Checks from a database of anonymised electronic medical records from participating general practices in England.