OBJECTIVES: To assess whether electronic (e-) coaching, using personalized web-based lifestyle and risk factor counselling with additional email prompts, provides additional risk reduction when added to standard of care (SOC) in individuals at increased risk. METHODS: Between June 2013 and May 2015, 402 participants were allocated 1:1 to e-coaching and SOC versus SOC. Participants free of manifest cardiovascular disease, with internet access, and a 10-year QRISK2 cardiovascular risk of ≥10% were enrolled. Change in oscillometric carotid-femoral pulse wave velocity (PWV) from baseline to six months was the primary endpoint. Secondary outcomes included change in blood pressure (BP), weight, and risk scores. Analysis was by intention to treat. RESULTS: Mean (±SD) age was 65.5 (5.6) years with 37% females. Primary outcome data were available for 94%. There was no difference in PWV reductions between e-coaching and standard of care groups (-0.16 m/s vs. -0.25 m/s, 95% confidence interval -0.39 to 0.22, p = 0.56). There were no differences in the improvement between groups for BP, weight, Framingham, or QRISK2 scores. Pulse wave velocity change was more favorable in those with a higher level of education (p = 0.04), but was not associated with age, gender, presence of diabetes, baseline QRISK2 score, or logins to the website. CONCLUSIONS: In individuals at increased cardiovascular risk, a comprehensive 'health check' program modestly reduced future risk. Personalized e-coaching did not provide added risk reduction. Currently there is no evidence to routinely recommend e-coaching in cardiovascular health check programs. TRIAL REGISTRATION: HAPPY London ClinicalTrials.gov: NCT01911910.