Ten biomarkers that predict longevity include ApoB, lipoprotein(a), hs-CRP, HbA1c, fasting insulin, GGT, homocysteine, vitamin D, uric acid, and cystatin C-based eGFR. These markers assess cardiovascular risk, metabolic health, inflammation, and organ function more accurately than standard annual labs. They reveal risks not captured by routine tests, helping forecast long-term health outcomes.
A standard annual physical usually runs a CBC, a basic metabolic panel, a standard lipid panel, and — if you push — a TSH and an HbA1c. That covers acute disease reasonably well. It is a surprisingly poor forecast of the two things that kill most adults: atherosclerotic cardiovascular disease and metabolic dysfunction.
The biomarkers below are the ones with the strongest outcome data for all-cause and cardiovascular mortality. Some are cheap. Some your PCP will happily add if you ask. A few you will almost certainly have to request by name.
1. ApoB — the number that should replace LDL-C
Apolipoprotein B counts the actual atherogenic particles in your blood: one ApoB per LDL, VLDL, IDL, and Lp(a) particle. LDL-C estimates cholesterol content; ApoB counts particles. When the two disagree — common in insulin resistance — ApoB wins on prediction.
A 2022 JAMA Cardiology analysis of UK Biobank data (Marston et al.) found ApoB was the principal driver of coronary risk, and that LDL-C and triglycerides added little once ApoB was accounted for. Optimal is generally cited around <80 mg/dL for average risk and <60 mg/dL for secondary prevention.
2. Lp(a) — the one-time test almost no one runs
Lipoprotein(a) is genetically determined, stable across your lifetime, and independently raises risk for MI, stroke, and aortic stenosis. Roughly 20% of the population has elevated Lp(a) and does not know it.
The European Atherosclerosis Society (2022 consensus) recommends measuring it at least once in every adult. Once. That is the entire ask. Values above ~50 mg/dL (or ~125 nmol/L) meaningfully shift the risk conversation and change how aggressively you target ApoB.
3. hs-CRP — inflammation you cannot feel
High-sensitivity C-reactive protein is a downstream signal of vascular and systemic inflammation. The JUPITER trial (Ridker, NEJM 2008) is the canonical citation: elevated hs-CRP predicted cardiovascular events even in patients with normal LDL.
Under 1.0 mg/L is low risk, 1–3 is average, >3 is elevated. A single high value can reflect a recent cold; repeat before drawing conclusions.
4. HbA1c — three months of glucose in one number
Most physicals include this now, but many stop at the diabetes cutoff of 6.5%. From a longevity standpoint, the interesting range starts at 5.7%. Prediabetes is where cardiovascular risk begins accelerating, well before a diabetes diagnosis.
Optimal for longevity is generally 4.9–5.4%. Above 5.6%, start paying attention.
5. Fasting insulin — the earliest signal of metabolic drift
Fasting glucose can look normal for years while insulin quietly climbs to keep it there. Fasting insulin is the earlier warning.
Optimal is typically <7 µIU/mL, with most metabolically healthy adults sitting between 2 and 5. It is cheap. It is rarely ordered. Ask for it.
If you only add two markers to your next draw, make them ApoB and fasting insulin. Together they cover the two biggest silent risks: atherogenic particles and early insulin resistance.
6. GGT — the liver enzyme that predicts more than liver disease
Gamma-glutamyl transferase shows up on comprehensive metabolic panels but is often ignored unless it is wildly abnormal. Multiple prospective cohorts (including a 2013 meta-analysis in Arteriosclerosis, Thrombosis, and Vascular Biology) link elevated GGT — even within the "normal" range — to cardiovascular mortality, type 2 diabetes, and all-cause mortality.
Think of it as an integrated marker of oxidative stress and metabolic burden. Optimal is generally <20 U/L in men, <15 U/L in women.
7. Homocysteine — the B-vitamin readout
Elevated homocysteine is associated with cardiovascular events, cognitive decline, and cerebral atrophy. Supplementation with B12, folate, and B6 lowers homocysteine reliably; whether that lowers hard endpoints is more contested. But the marker itself is a useful readout of B-vitamin status and methylation.
Aim for <9 µmol/L. Values above 12 warrant a workup.
The takeawayA "normal" annual physical can miss elevated Lp(a), rising ApoB, early hyperinsulinemia, and low-grade inflammation — the exact processes that quietly build the disease you will eventually be diagnosed with.
8. Vitamin D (25-OH) — the modifiable one everyone under-tests
Vitamin D deficiency is associated with higher all-cause mortality, worse cardiovascular outcomes, and impaired immune function. Causality is debated for some endpoints, but the correction is cheap, safe within reason, and the baseline test is inexpensive.
Most longevity-oriented clinicians target 40–60 ng/mL. Under 30 is deficient; under 20 is meaningfully deficient.
9. Uric acid — the marker hiding in plain sight
Beyond gout, uric acid tracks with hypertension, metabolic syndrome, kidney disease, and cardiovascular events. It is on most comprehensive panels and almost universally ignored until a toe swells.
Men: target <6 mg/dL. Women: <5 mg/dL. Elevations often respond to reducing fructose and alcohol before medication is on the table.
10. eGFR + cystatin C — kidney function, done properly
Standard eGFR is calculated from creatinine, which is confounded by muscle mass. A muscular 45-year-old can look like they have early kidney disease; a frail 75-year-old can look fine when they are not.
Cystatin C-based eGFR is not muscle-dependent and is a stronger predictor of cardiovascular and all-cause mortality (Shlipak et al., NEJM 2013). If your creatinine-based eGFR looks odd for your body composition, ask for cystatin C.
Why your annual physical misses half of these
Insurance-driven panels are built around diagnosing disease that already exists, not quantifying risk for disease you might develop over the next 20 years. Lp(a), ApoB, fasting insulin, and cystatin C are not standard because they do not change this year's billing code. They change your next two decades.
The practical fix is short: know which markers you actually want, and ask for them by name. Most primary care physicians will add ApoB, Lp(a), hs-CRP, and fasting insulin without argument if you request them.
How to actually use these numbers
One draw is a snapshot. Trends are the signal. A single hs-CRP of 4 mg/L means little; three draws averaging 4 mg/L over a year means something. Establish a baseline, retest the movable markers (ApoB, hs-CRP, HbA1c, fasting insulin, vitamin D) every 6–12 months, and retest the fixed ones (Lp(a)) essentially never.
Interpretation matters more than collection. "Normal" on a lab report means "within two standard deviations of the reference population" — a population that includes plenty of people on the path to disease. Optimal ranges are tighter than normal ranges, and the difference is where longevity work actually happens.
If you want a workup that goes beyond the standard physical, the panel worth having covers ApoB, Lp(a) (once), a full lipid panel, hs-CRP, HbA1c, fasting insulin, comprehensive metabolic panel with GGT and uric acid, 25-OH vitamin D, homocysteine, and cystatin C. That is roughly 10 additional data points beyond a typical annual draw — and it is the difference between screening for disease and forecasting it.
References
- Kronenberg F et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022. Source
- Koschinsky ML et al. A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice. J Clin Lipidol. 2024. Source
- Ridker PM A Test in Context: High-Sensitivity C-Reactive Protein. J Am Coll Cardiol. 2016. Source
- Bassuk SS et al. High-sensitivity C-reactive protein: clinical importance. Curr Probl Cardiol. 2004. Source
Real labs. Plain-English plan.
A clinician-ordered, 80+ biomarker panel. Results in 3–5 days, with a personalized roadmap from a US-licensed clinician — not a chart you have to decode yourself.
See my numbers →Editorial disclosure: This article is for informational purposes only and does not constitute medical advice. All treatments at DirectCare AI are prescribed by US-licensed clinicians based on individual medical evaluation. Compounded medications are not FDA-approved and are not reviewed by the FDA for safety, effectiveness, or quality. Always consult a US-licensed clinician before starting or changing any therapy.
