Where Do I Start?
New to longevity testing? This guide walks you through the essential first panel every adult should get, what the results mean, and how to build from there.
Key Takeaways
- →A comprehensive metabolic and lipid panel is the best starting point for any adult over 30.
- →Adding ApoB, hsCRP, and fasting insulin to a standard panel dramatically increases its predictive value.
- →A coronary calcium score (or CT coronary angiography if risk factors are present) is one of the most powerful predictors of cardiac events available.
- →DEXA, whole exome sequencing, and pharmacogenomic testing round out a truly comprehensive baseline assessment.
- →Test at least annually; semi-annually if you are actively optimizing lifestyle or medication.
- →Always interpret results in context with a knowledgeable physician — isolated numbers rarely tell the full story.
If you are new to longevity testing, the sheer number of available biomarkers can feel overwhelming. Hundreds of tests exist, ranging from a simple lipid panel to whole-genome sequencing. The good news: you do not need all of them. A well-chosen starting panel of 15–20 markers can reveal the vast majority of modifiable risk factors for cardiovascular disease, metabolic dysfunction, and chronic inflammation — the three pillars that drive most age-related disease.
The Essential Starting Panel
The American Heart Association, European Society of Cardiology, and leading longevity physicians broadly agree on a core set of markers. Below is the panel we recommend as a minimum baseline for any health-conscious adult.
- •Lipid panel — Total cholesterol, LDL-C, HDL-C, triglycerides, and ideally ApoB. ApoB is increasingly recognized as the single best lipid marker for cardiovascular risk, superior to LDL-C alone (European Heart Journal, 2021).
- •Metabolic markers — Fasting glucose, HbA1c, and fasting insulin. HbA1c reflects your average blood sugar over 2–3 months. Fasting insulin can detect insulin resistance years before glucose rises.
- •Inflammatory markers — High-sensitivity C-reactive protein (hsCRP). Elevated hsCRP is independently associated with increased cardiovascular events, even when cholesterol is normal (JUPITER trial, NEJM 2008).
- •Liver function — ALT and GGT. Elevated ALT may indicate non-alcoholic fatty liver disease (NAFLD), which affects roughly 25% of adults globally (Journal of Hepatology, 2016).
- •Kidney function — eGFR and creatinine. Chronic kidney disease is often asymptomatic until advanced stages.
- •Thyroid — TSH at minimum, plus free T4 if TSH is abnormal.
- •Complete blood count (CBC) — Screens for anemia, infection, and blood disorders.
Why ApoB should be in every panel
A 2022 meta-analysis in JAMA Cardiology found that ApoB was a stronger predictor of cardiovascular events than LDL-C across all levels of discordance. The European Atherosclerosis Society now recommends ApoB as a primary target for lipid-lowering therapy.
How to Interpret Your Results
Lab reference ranges are based on population averages — not optimal health. A result that falls within the "normal" range may still indicate elevated risk. For example, a fasting glucose of 99 mg/dL is technically normal but sits at the upper boundary of the reference range and may reflect early metabolic dysfunction. Longevity-oriented physicians often target tighter optimal ranges.
Do not self-diagnose from lab results
Biomarkers should always be interpreted by a qualified physician in the context of your full medical history, medications, and symptoms. A single out-of-range result does not necessarily indicate disease.
How Often to Test
For most adults, annual testing is sufficient to track trends. If you are making significant lifestyle changes (diet, exercise, sleep) or starting a new medication (such as a statin), retesting after 3–6 months helps assess your response. Some markers like Lp(a) are genetically determined and only need to be tested once.
Where to Get Tested
You have several options: your primary care physician can order most of these tests and they may be covered by insurance. Direct-to-consumer services like Function Health and InsideTracker offer comprehensive panels without a doctor's order. Quest Diagnostics and Labcorp also offer self-pay options. Whichever route you choose, consistency matters — try to use the same lab each time for comparable results.
Cardiac Calcium Scoring & CT Coronary Angiography
Beyond blood work, a coronary artery calcium (CAC) score is one of the most valuable tests you can get. It uses a low-dose CT scan to directly quantify calcified plaque in your coronary arteries — giving you a concrete measure of atherosclerotic burden rather than just risk factors. A CAC score of zero is highly reassuring and associated with very low 10-year cardiac event rates. Any score above zero warrants a conversation with your physician about aggressive risk factor management.
If you have existing risk factors — elevated ApoB, family history of premature heart disease, diabetes, hypertension, or a prior CAC score above zero — consider CT coronary angiography (CCTA) instead. CCTA provides detailed anatomical imaging of the coronary arteries and can detect both calcified and non-calcified (soft) plaque, which a standard CAC score misses. Non-calcified plaque is particularly dangerous because it is more prone to rupture and cause acute events.
CAC as a predictor of cardiac events
The Multi-Ethnic Study of Atherosclerosis (MESA) demonstrated that a CAC score is among the strongest independent predictors of future cardiovascular events — superior to traditional risk factor calculators alone. The SCOT-HEART trial showed that CCTA changed management in one-third of patients and reduced coronary heart disease death and non-fatal MI at 5 years.
DEXA Scan
A dual-energy X-ray absorptiometry (DEXA) scan provides precise measurements of bone mineral density, lean muscle mass, and body fat distribution — including visceral adipose tissue, the metabolically dangerous fat surrounding your organs. Unlike a bathroom scale or BMI, DEXA distinguishes between fat and muscle and tells you where each is distributed. This is critical for longevity: sarcopenia (age-related muscle loss) is a major driver of frailty and mortality, while excess visceral fat is strongly associated with insulin resistance, cardiovascular disease, and certain cancers.
DEXA is also the gold standard for osteoporosis screening. Bone density declines silently for decades before a fracture occurs, especially in women post-menopause. A baseline DEXA in your 30s or 40s allows you to track changes over time and intervene early with resistance training, nutrition, and — if necessary — medication.
Whole Exome Sequencing
Whole exome sequencing (WES) analyzes the protein-coding regions of all ~20,000 human genes — the roughly 1–2% of your genome that accounts for approximately 85% of known disease-causing variants. Unlike consumer SNP panels (23andMe, AncestryDNA), which test a limited set of pre-selected variants, WES can identify rare pathogenic mutations that those panels miss entirely.
WES is particularly valuable for uncovering hereditary conditions such as familial hypercholesterolemia (affecting ~1 in 250 people, most undiagnosed), BRCA1/BRCA2 mutations conferring elevated breast and ovarian cancer risk, Lynch syndrome predisposing to colorectal cancer, and cardiomyopathy-associated variants. Many of these conditions are actionable — early detection enables surveillance protocols and preventive interventions that meaningfully reduce morbidity and mortality.
Genetic counseling is essential
WES results should always be reviewed with a certified genetic counselor. Variants of uncertain significance (VUS) are common and require expert interpretation. A genetic counselor can distinguish clinically actionable findings from incidental or benign variants and guide appropriate follow-up.
Pharmacogenomic Testing
Pharmacogenomic (PGx) testing analyzes genes that affect how your body metabolizes medications — primarily the cytochrome P450 enzyme family (CYP2D6, CYP2C19, CYP2C9, CYP3A4) along with other drug-processing genes. The results classify you as a poor, intermediate, normal, rapid, or ultra-rapid metabolizer for specific enzyme pathways, which directly impacts drug efficacy and adverse reaction risk.
This has immediate clinical relevance. Poor metabolizers of CYP2C19, for example, may not adequately activate clopidogrel (Plavix), a common antiplatelet drug — leaving them at risk for stent thrombosis. Ultra-rapid metabolizers of CYP2D6 can convert codeine to morphine at dangerously high rates. PGx testing also guides dosing for statins, antidepressants (SSRIs, SNRIs), blood thinners (warfarin), proton pump inhibitors, and many other commonly prescribed drugs.
One test, lifetime value
Your pharmacogenomic profile does not change over time. A single PGx test provides a permanent reference that can guide medication decisions for the rest of your life — making it one of the highest-value tests relative to its cost.
Next Steps After Your First Panel
Once you have baseline results from your blood work, imaging, and genetic testing, you can make informed decisions about which areas to monitor more closely. If cardiovascular markers are borderline, your CAC score or CCTA will clarify your actual plaque burden. If metabolic markers are concerning, continuous glucose monitoring (CGM) may provide actionable insight. If everything looks good, retest blood work in 12 months and consider adding biological age testing to track your rate of aging over time.