Which blood tests are best for tracking longevity?
You do not need an expensive 'longevity panel' to track how well you are ageing. A handful of standard blood tests — for cholesterol particles, blood sugar, inflammation and organ function — predict long-term health far better than most premium tests, and cost a fraction as much.
The blood tests with the strongest evidence for predicting long-term health are a short, inexpensive panel: ApoB (or non-HDL cholesterol), lipoprotein(a) once in a lifetime, HbA1c with fasting glucose and insulin, high-sensitivity CRP, a full blood count with ferritin, kidney and liver function, and thyroid. Each is tied to hard outcomes in large cohorts and, crucially, each changes a decision. Epigenetic-age tests and most 'longevity panels' add cost without adding a decision.
- ApoB is the single best routine blood measure of cardiovascular risk — better than LDL cholesterol — and cardiovascular disease remains the leading cause of death. Test it, treat it, retest it.
- Lipoprotein(a) is largely genetic, needs measuring only once, and identifies roughly one in five people with a risk their standard lipid panel does not show.
- HbA1c, fasting glucose and fasting insulin together catch metabolic disease years before diagnosis, when it is still reversible with lifestyle change.
- hs-CRP tracks low-grade inflammation, which predicts cardiovascular events independently of cholesterol — but it moves with any infection, so a single high result needs repeating.
- Biological-age and 'longevity' panels are real science with poor individual precision. They rarely change what you would do, which is the only reason to run a test.
The core panel
Ranked on: how strongly the marker predicts mortality or major disease in large human cohorts, and whether an abnormal result leads to a proven intervention. A marker with strong prediction and no actionable response ranks below one with both.
| # | Option | Verdict | Grade |
|---|---|---|---|
| 1 | ApoB (apolipoprotein B) | Best single cardiovascular marker | GRADE AEstablished |
| 2 | Lipoprotein(a) | Once, for everyone | GRADE AEstablished |
| 3 | HbA1c, fasting glucose and fasting insulin | Metabolic disease, years early | GRADE AEstablished |
| 4 | hs-CRP (high-sensitivity C-reactive protein) | Inflammation; repeat before acting | GRADE BPromising |
| 5 | Full blood count and ferritin | Catches the common causes of fatigue | GRADE BPromising |
| 6 | Kidney function (eGFR, creatinine) and liver enzymes | Organ reserve; essential before any stack | GRADE BPromising |
| 7 | Thyroid (TSH, with free T4 if abnormal) | Common, treatable, often missed | GRADE BPromising |
| 8 | Vitamin D (25-hydroxy) | Test to decide whether to supplement | GRADE BPromising |
| 9 | Omega-3 index | Useful, not essential | GRADE CEarly |
| 10 | Epigenetic age tests | Real science, poor precision, no decision | GRADE CEarly |
- 01
ApoB (apolipoprotein B)
GRADE AEstablishedBest single cardiovascular markerCounts the number of atherogenic lipoprotein particles rather than the cholesterol they carry, which is why it predicts cardiovascular events better than LDL cholesterol — particularly in people with high triglycerides or metabolic syndrome, whose LDL can look normal while their particle count is not. Cardiovascular disease is the leading cause of death worldwide; this is the test that tracks it. Where ApoB is unavailable, non-HDL cholesterol is the next-best proxy.
- 02
Lipoprotein(a)
GRADE AEstablishedOnce, for everyoneA genetically determined particle that raises cardiovascular risk independently of everything else on a lipid panel, elevated in roughly one adult in five, and unaffected by diet or statins. Because it barely changes across a lifetime, one measurement is enough. Knowing it is high justifies treating every other risk factor more aggressively — which is why the major cardiology societies now recommend testing it once in every adult.
- 03
HbA1c, fasting glucose and fasting insulin
GRADE AEstablishedMetabolic disease, years earlyHbA1c gives a three-month average of blood glucose; fasting insulin rises years before glucose does as the body compensates for insulin resistance. Together they identify metabolic dysfunction while it is still fully reversible with weight, diet and activity — the window in which intervention has its best evidence. Type 2 diabetes roughly doubles cardiovascular risk and shortens life; catching the pre-diabetic decade is among the highest-value things a blood test can do.
- 04
hs-CRP (high-sensitivity C-reactive protein)
GRADE BPromisingInflammation; repeat before actingChronic low-grade inflammation predicts cardiovascular events independently of cholesterol, and hs-CRP is its standard marker. The caveat is that it rises sharply with any infection, injury or poor sleep, so a single elevated reading means little. Two readings a month apart, both raised, is a signal worth acting on — usually through the same metabolic and lifestyle changes that lower the markers above.
- 05
Full blood count and ferritin
GRADE BPromisingCatches the common causes of fatigueIron deficiency is the most common nutritional deficiency in the world and a leading cause of the fatigue people try to treat with supplements. Ferritin finds it; a full blood count finds anaemia and the occasional serious haematological problem. Cheap, standard, and more likely to explain low energy than anything sold for it.
- 06
Kidney function (eGFR, creatinine) and liver enzymes
GRADE BPromisingOrgan reserve; essential before any stackKidney and liver function decline silently and determine how safely you can take most medicines and supplements. Fatty liver, now the most common liver condition worldwide, shows up first as mildly raised enzymes. Anyone taking a supplement stack should have both checked before starting and periodically after.
- 07
Thyroid (TSH, with free T4 if abnormal)
GRADE BPromisingCommon, treatable, often missedThyroid dysfunction is common, under-diagnosed, and a frequent hidden cause of fatigue, weight change and low mood — the symptoms people bring to longevity clinics. TSH alone screens it; the full panel is only needed if TSH is abnormal.
- 08
Vitamin D (25-hydroxy)
GRADE BPromisingTest to decide whether to supplementWorth measuring precisely because supplementation only helps people who are deficient. A result tells you whether vitamin D belongs in your routine at all — one of the few cases where a blood test directly settles a supplement question.
- 09
Omega-3 index
GRADE CEarlyUseful, not essentialMeasures EPA and DHA in red-cell membranes and correlates with cardiovascular outcomes in cohort studies. It is most useful for deciding whether omega-3 supplementation is likely to help you — the benefit is clearest at low baseline levels. A reasonable addition, not a core marker.
Methylation clocks track ageing at a population level and are far less precise for one individual than the single number on the report implies; test-to-test noise in the same person can exceed a year. No trial has shown that lowering a clock reading improves outcomes, and the markers above predict at least as well for a fraction of the price. Interesting; rarely decisive.
What most 'longevity panels' add — and why it rarely matters
Common premium-panel markers and their actual value
| Marker | What it is sold as | Evidence reality | Verdict |
|---|---|---|---|
| Telomere length | A cellular age readout | Population-level association; large measurement variability; no trial shows changing it helps | Skip |
| NAD⁺ level | Cellular energy status | No validated reference range; no outcome link; rises with supplementation without proven benefit | Skip |
| Full hormone panel in healthy adults | Optimisation baseline | Testosterone, oestradiol and DHEA are worth testing with symptoms; routine 'optimisation' has no outcome evidence | Only with symptoms |
| Heavy-metal and micronutrient screens | Toxin and deficiency mapping | Occasionally useful with a specific exposure or symptom; broad screens generate incidental findings without decisions | Targeted only |
| Advanced lipid particle sizing | Beyond ApoB | Once you have ApoB, particle-size sub-fractions add cost without changing treatment | Skip if ApoB done |
| Proteomic and 'organ age' panels | Next-generation ageing clocks | Promising research tools; not validated for individual decisions | Not yet |
How often to test, and how to read the trend
- Lipoprotein(a): once in a lifetime. It does not meaningfully change.
- ApoB, HbA1c, fasting insulin, hs-CRP: at baseline, then every six to twelve months, or three months after any deliberate change to diet, training or a medicine.
- Full blood count, ferritin, kidney, liver, thyroid, vitamin D: annually, or before and after starting any new supplement stack or prescription.
- Read every marker as a trend across draws, not a verdict from one. Fast, hydration, time of day and recent illness all move results; a single surprising value should be repeated before it changes anything.
Frequently asked questions
What is the single most important blood test for longevity?
ApoB. It counts the atherogenic particles that drive cardiovascular disease — still the leading cause of death — and predicts events better than standard LDL cholesterol, particularly in people with metabolic syndrome whose LDL can look deceptively normal. It is cheap, widely available and directly actionable.
Do I need an expensive longevity blood panel?
Almost never. The markers that predict long-term outcomes — ApoB, Lp(a), HbA1c, fasting insulin, hs-CRP, organ function, thyroid, ferritin, vitamin D — are all standard tests. Premium panels add markers like telomere length and NAD⁺ that have no validated reference range and change no decision.
Should I test lipoprotein(a)?
Yes, once. Around one adult in five has an elevated level that standard cholesterol tests do not show, it is almost entirely genetic and does not change with diet, and knowing it is high justifies treating every other risk factor more aggressively. Major cardiology societies now recommend a single lifetime measurement for all adults.
Are biological age tests worth it?
Rarely. Epigenetic clocks are genuine science, but a single result for one person carries more noise than the confident number suggests, no trial has shown that lowering a clock reading improves health, and standard markers predict outcomes at least as well for far less. They are interesting; they are seldom decisive.
How often should I get longevity blood tests?
Lp(a) once; ApoB, HbA1c, insulin and hs-CRP every six to twelve months or three months after a deliberate change; organ function, thyroid, ferritin and vitamin D annually or around any new supplement or medicine. Always read results as a trend across draws rather than reacting to one.
Which blood tests explain low energy?
Ferritin, a full blood count, thyroid (TSH), HbA1c with fasting insulin, and vitamin D. Between them they catch iron deficiency, anaemia, thyroid dysfunction, early metabolic disease and vitamin D deficiency — the common, treatable causes of fatigue that people try to fix with supplements before testing.
Keep reading
- Best longevity blood tests and biomarkers to monitor
Targets, retest intervals and noise bands for each marker on this list.
- Biological age tests: what they measure and what they miss
Epigenetic clocks — real science, poor individual precision.
- VO₂ max testing for longevity
The fitness measure that predicts mortality better than most blood tests.
- Early disease detection
Screening, imaging and blood-based detection — what has evidence and what is marketing.
- Longevity clinics vs traditional healthcare
What a clinic panel adds over your physician's — and what it charges for.
- Free stack check
Screen a supplement routine against your medication and your results.
More in Biomarkers & testing
- What lab tests monitor efforts to extend lifespan?
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- Best longevity blood tests and biomarkers to monitor.
The monitoring guide: each longevity biomarker with its evidence-based target range, how often to retest, what moves it, and when a change means something rather than noise.
- VO2 max testing for longevity: what it measures, and what the evidence actually shows
VO2 max is one of the strongest predictors of all-cause mortality in the research. What the test actually measures, how accurate estimates are, and where to get one.
- Biological age tests: what they measure and what they miss
Epigenetic clocks are real science with real limits. What each test measures, how much your result can move between draws, and when it changes a decision.