Standard labs miss most of what matters

The typical annual physical includes a lipid panel, basic metabolic panel, and a CBC. This is a screening starting point — it is not a longevity evaluation. Most of the metrics that meaningfully predict long-term cardiometabolic risk, cognitive trajectory, and healthspan are simply not measured in that visit.

Cardiometabolic markers worth tracking

• ApoB: the more reliable predictor of cardiovascular risk than LDL. It counts the actual number of atherogenic particles, which can be high even when LDL looks “normal.”
• Lp(a): a genetic risk factor. Measure once in a lifetime. Elevated levels multiply cardiovascular risk and often warrant more aggressive management of other factors.
• Fasting insulin: rises long before fasting glucose does. Elevated insulin with normal glucose is one of the earliest signals of metabolic dysfunction.
• HbA1c: 3-month average blood sugar. Ideal is under 5.4%; the “prediabetic” cutoff of 5.7% is late.
• Homocysteine: elevated levels correlate with cardiovascular and cognitive risk. B vitamins can normalize.
• hs-CRP: high-sensitivity C-reactive protein. Chronic inflammation marker.

Hormonal and micronutrient markers

• Vitamin D (25-OH): deficiency is common; optimal is 40–60 ng/mL in most contexts.
• Ferritin: iron stores. Low ferritin correlates with fatigue and cognitive symptoms; very high ferritin (with normal iron saturation) can indicate inflammation.
• Vitamin B12 and folate: neurological and hematologic function.
• Thyroid panel: TSH alone is inadequate. A full panel includes free T3, free T4, and thyroid antibodies.
• Full hormone panel by sex/age: testosterone, estradiol, progesterone, DHEA-S depending on context.

Kidney and liver function beyond the basics

• Cystatin C: a more accurate kidney function marker than creatinine alone, especially in muscular or older patients.
• GGT: liver enzyme sensitive to alcohol, metabolic dysfunction, and oxidative stress.
• Uric acid: elevated levels correlate with metabolic syndrome and cardiovascular risk beyond gout.

Inflammatory and immune markers

• Neutrophil-to-lymphocyte ratio (NLR): derived from CBC, tracks chronic inflammation and immune balance.
• hs-CRP: as above.
• Homocysteine: as above.

Emerging markers worth watching (not yet standard)

• Biological age panels (methylation-based clocks): interesting but still research-grade for individual decisions.
• OMICmAge, GrimAge, PhenoAge: various algorithms combining standard markers into age estimates.

We do not recommend basing treatment decisions on these alone until the evidence matures further.

How often to test

Baseline comprehensive panel, then annually for most patients, or every 3–6 months when actively managing a specific issue like elevated ApoB or hormone therapy adjustment.

Next steps

If you’ve been told “your labs are normal” but you’re not confident that means “optimal,” a comprehensive longevity workup is a different tool. Book a consultation.