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Enter your results to see how each compares with the categories clinicians use, such as the American Diabetes Association's HbA1c cut-offs or the NIH's vitamin D ranges. Every category links to its source.
Most standard annual bloodwork panels are designed to detect disease, not to optimize longevity. A longevity-focused panel is different in scope, in the reference ranges used for interpretation, and in how frequently certain markers should be tracked.
The following biomarkers should be tested at least annually for any adult over 35 interested in proactive longevity medicine. These are either widely available through standard lab orders or easily accessible through direct-to-consumer lab services.
LDL cholesterol, HDL cholesterol and triglycerides (the standard lipid panel), ApoB (counts atherogenic particles; most informative when it and LDL disagree), Lp(a) (levels are largely inherited) and hsCRP (an inflammation marker used to refine cardiovascular risk).
HbA1c and fasting glucose (the standard tests for prediabetes and diabetes), fasting insulin and HOMA-IR (useful for tracking insulin resistance, although there are no agreed cut-offs), ALT (a liver enzyme whose healthy upper limit is lower than many lab ranges), eGFR (kidney function) and uric acid.
TSH (with free T4 if TSH is abnormal), 25-OH vitamin D (20 to 50 ng/mL is generally adequate), vitamin B12, the omega-3 index and, for men with symptoms, a morning total testosterone.
Not all longevity biomarkers come from blood. VO₂max (the single strongest longevity predictor — test via graded exercise test or validated field test like the 12-minute Cooper test), grip strength (dynamometry — the Lancet PURE study found it predicted cardiovascular mortality better than blood pressure in 140,000 people), and resting heart rate (below 60 bpm reflects strong cardiovascular efficiency). HRV (heart rate variability) via a wearable adds daily trend data that lab tests cannot provide.
Once the Tier 1 panel is established as a baseline, the following tests add meaningful depth for adults serious about longevity optimization. They are more expensive and less universally available, but provide information not obtainable through standard panels.
CAC Score (Coronary Artery Calcium): A CT scan of the coronary arteries that directly measures calcified atherosclerotic plaque — the actual disease, not risk factors for it. A CAC of zero in someone over 40 is extremely reassuring even with other risk factors. A CAC above 300 requires aggressive intervention. This should be done once at age 40–45 and repeated if non-zero. Cost: approximately $100–200 out-of-pocket, not typically covered by insurance for preventive use.
DEXA Scan (Body Composition): Provides accurate lean mass, fat mass, bone density, and visceral fat area. BMI is nearly useless for longevity purposes — DEXA gives you the actual numbers that predict health outcomes. Low muscle mass index (Srikanthan et al., AJMED 2014) independently predicts mortality. High visceral fat area drives metabolic dysfunction even in people with normal BMI. Cost: $50–150; worth doing annually once you have a baseline.
Omega-3 Index: Measures EPA and DHA as a percentage of total fatty acids in red blood cell membranes — a 3-month average of omega-3 status. Below 4% is associated with high cardiovascular risk. In the paper that proposed it, 8% or more was linked to the lowest risk. Unlike blood plasma omega-3 tests, the RBC index is not acutely affected by recent fish consumption. Available through companies like OmegaQuant for approximately $60.
Epigenetic Age Testing: Tests like GrimAge (TruMe), GlycanAge, and the Levine PhenoAge bloodwork panel provide a direct estimate of biological age using DNA methylation patterns or protein glycosylation. These are the gold standard for biological age measurement — far more accurate than any questionnaire-based tool, including our own Biological Age Calculator. They are expensive ($300–500) but provide a baseline that is worth establishing in your 40s and tracking every 2–3 years. GrimAge specifically has the strongest longitudinal evidence for predicting mortality and healthspan decline.
A lab's reference range describes the middle 95% of results in healthy people. Clinical guidelines add cut-offs where the risk of disease or the need for treatment changes, such as the HbA1c levels that define prediabetes and diabetes. Those are the categories this tool uses, and each one links to its source.
Many longevity sites go further and grade results against tighter "optimal" ranges, such as an HbA1c below 5.3% or vitamin D of 40 to 60 ng/mL. For most markers no guideline defines such a range, and some are contradicted by the evidence: the NIH notes that vitamin D above 50 ng/mL can be associated with adverse effects, and in the VITAL trial, vitamin D supplements did not reduce cancer or cardiovascular events in generally healthy adults.
For some markers, risk keeps falling as the number improves. LDL cholesterol is the clearest example, which is why US guidelines base treatment on your overall cardiovascular risk rather than on a single "normal" value. A result in the usual range is reassuring but not a guarantee, and one outside it is a reason to talk with your clinician, not a diagnosis.
What to test, when, what to ask for and how to read the results. Free, unsubscribe anytime.