The standard annual panel was designed to find existing disease. Longevity medicine asks a different question: how fast are you aging?
By Dr. Teja V. Surapaneni, MD, MS • Board-Certified Internal Medicine • May 2026
The standard annual physical panel (CBC, CMP, lipids, glucose) was designed to detect and manage existing disease. Longevity medicine requires a different set of questions: what is your trajectory, and how fast are you aging? These biomarkers provide the answer.
Standard chemistry panels and CBC are valuable. But they are designed to flag current disease, not to predict future disease decades away. For example:
The longevity biomarker panel fills these gaps.
ApoB (Apolipoprotein B): Every atherogenic particle — LDL, VLDL, IDL, Lp(a) — carries one ApoB molecule. ApoB is therefore a direct count of the number of atherogenic particles in circulation, which is more predictive of cardiovascular events than LDL-C. Target: <90 mg/dL for average risk; <70 mg/dL for those with cardiovascular disease or diabetes. Statins lower ApoB. Optimal target: as low as achievable without statin side effects in high-risk individuals.
Lp(a) (Lipoprotein(a)): An LDL-like particle with pro-inflammatory and pro-thrombotic properties. Levels are 80–90% genetically determined and not significantly modified by lifestyle or most medications. Present in elevated concentrations (>50 mg/dL or >125 nmol/L) in approximately 20% of people. Associated with a 2–3× increase in cardiovascular risk. Check once — levels are essentially stable for life. RNA-targeting therapies (in late-stage trials as of 2026) are expected to become the first effective Lp(a)-lowering treatment.
hsCRP (high-sensitivity C-reactive protein): A marker of systemic inflammation. Elevated hsCRP (>2.0 mg/L) independently predicts cardiovascular events and is associated with accelerated biological aging. Target: <1.0 mg/L. Elevated hsCRP should prompt investigation of causes: smoking, obesity, periodontal disease, sleep apnea, occult infection, or autoimmune disease.
Fasting insulin: Insulin resistance precedes type 2 diabetes by 10–20 years. Fasting glucose becomes abnormal only after beta cell function starts declining. Fasting insulin, by contrast, rises early in insulin resistance. Target fasting insulin: <6 µIU/mL. Values above 10 indicate significant insulin resistance even with normal glucose.
HOMA-IR (Homeostatic Model Assessment of Insulin Resistance): Calculated from fasting insulin and fasting glucose: (insulin × glucose) / 405. Target: <1.5. Values above 2.5 indicate insulin resistance; above 5.0 indicate severe insulin resistance.
DHEA-S (Dehydroepiandrosterone sulfate): DHEA-S is an adrenal androgen that peaks in the mid-20s and declines ~1–2% per year thereafter. Low DHEA-S correlates with increased all-cause mortality, cognitive decline, and loss of muscle mass in observational studies. It is often described as one of the most reliable markers of biological age — though intervention studies on DHEA supplementation are modest and mixed.
IGF-1 (Insulin-like growth factor-1): The primary downstream mediator of growth hormone (GH). IGF-1 reflects lifetime exposure to growth signals — high IGF-1 is associated with accelerated aging and cancer risk in some populations; low IGF-1 is associated with frailty and muscle loss. The longevity-optimal range appears to be in the middle-to-upper portion of the age-adjusted normal range, not maximized. Context-dependent interpretation is required.
Homocysteine: An amino acid derivative that is a direct toxic to vascular endothelium at elevated levels. Elevated homocysteine (>12 µmol/L) is associated with cardiovascular disease, stroke, and dementia. Usually caused by B12, folate, or B6 deficiency — correctable with supplementation. Target: <10 µmol/L.
RBC magnesium (not serum magnesium): Serum magnesium is maintained at normal levels until deficiency is severe, making it a late and insensitive marker. RBC magnesium reflects intracellular magnesium status, which correlates with cardiovascular function, blood pressure, glucose metabolism, and sleep quality. Approximately 50% of Americans are estimated to be magnesium-insufficient by RBC standards despite normal serum levels.
CAC score (Coronary Artery Calcium): A CT scan that quantifies calcified plaque in the coronary arteries. CAC = 0 indicates very low cardiovascular risk (10-year event rates <2% in most studies); CAC >300 indicates high risk and typically triggers aggressive lipid management. The most powerful tool for reclassifying intermediate-risk patients who may or may not benefit from statin therapy. A single scan provides roughly 10 years of useful prognostic data.
VO2max: Maximal aerobic capacity, measured during a graded exercise test. The strongest single predictor of all-cause mortality across all age groups — stronger than smoking, hypertension, diabetes, or cholesterol in some analyses. A 1-MET improvement in VO2max (achievable with 3–4 months of structured training) is associated with approximately 13% reduction in all-cause mortality risk. Target: age-adjusted elite fitness category if achievable.
Not all of these need to be checked annually. A practical framework:
The goal is trajectory — not a single number. A rising HOMA-IR over three years tells a different story than a stable one at the same absolute value.
If forced to choose one, VO2max has the strongest single-predictor relationship to all-cause mortality. For blood tests, ApoB and fasting insulin catch the two most common causes of premature death and disability (cardiovascular disease and metabolic dysfunction) earlier and more accurately than standard lipid and glucose panels.
Most annually, some less frequently. Lp(a) only needs to be checked once (genetically determined). CAC is useful every 5–10 years after age 40-45. ApoB, hsCRP, and metabolic markers benefit from annual tracking to assess trajectory.
ApoB is a protein carried on every atherogenic particle — LDL, VLDL, IDL, and Lp(a). It directly counts the number of dangerous particles, while LDL-C estimates their combined cholesterol content. Particle count is a better predictor of cardiovascular events than cholesterol content, which is why ApoB outperforms LDL-C in most comparative studies.
Most are highly modifiable. ApoB responds to statins, PCSK9 inhibitors, and dietary changes. Fasting insulin and HOMA-IR respond dramatically to weight loss, exercise, and dietary composition. hsCRP responds to anti-inflammatory lifestyle changes. VO2max improves with aerobic training. Lp(a) is the notable exception — largely genetically fixed.
This article is for informational purposes only and does not constitute medical advice. Always consult with a licensed physician before starting any medication.
No credit card required. Live MD consult included.