My doctor told me my cholesterol was “fine.” Total cholesterol: 195. “Within normal range.” I went home, ordered an ApoB test on my own, and found out my ApoB was 110 mg/dL — a value longevity medicine practitioners would flag and most general practitioners wouldn't even order.
That gap — between “clinically normal” and “optimized for longevity” — is the whole point of this piece. Standard bloodwork panels were designed to detect disease, not to optimize healthspan. The reference ranges are based on population averages, which means “normal” is what's typical for a population that has a 50% lifetime cardiovascular disease risk.
Getting the Right Tests
You need to be proactive. Your primary care physician may not order all of these. Options: request specific tests from your doctor, or use a direct-to-consumer lab service. Marek Health specializes in comprehensive longevity panels and works with physicians who understand optimal (not just normal) ranges. The blood draw process is through LabCorp or Quest (nationwide), and results come with practitioner review.
The Core Longevity Biomarkers
1. ApoB (Apolipoprotein B)
Every atherogenic lipoprotein particle — LDL, VLDL, IDL, Lp(a) — has exactly one ApoB molecule. ApoB is the molecule that embeds in arterial walls and initiates atherosclerosis. Counting ApoB counts the particles. Standard LDL-C measures the cholesterol content inside those particles, which is a less direct measure.
A 2021 analysis in the European Heart Journal (Boren et al.) confirmed that ApoB is causally associated with cardiovascular disease in Mendelian randomization studies.
- Lab reference range: <130 mg/dL
- Longevity target: <90 mg/dL
- Aggressive prevention target (high-risk individuals): <70 mg/dL
2. Lp(a) — Lipoprotein(a)
Lp(a) is a genetically determined lipoprotein that dramatically increases cardiovascular risk — independent of diet, exercise, or lifestyle. Roughly 20% of the population has Lp(a) levels high enough to significantly increase CVD risk. A 2022 consensus statement from the European Society of Cardiology recommends measuring Lp(a) at least once in every adult's lifetime.
- Optimal: <30 mg/dL (or <75 nmol/L)
- High risk: >50 mg/dL (>125 nmol/L)
RNA therapeutics targeting Lp(a) specifically are in late-stage trials. Worth knowing about now.
3. HbA1c and Fasting Insulin
HbA1c reflects your average blood glucose over the past 90 days. A 2021 study in Diabetologia found that HbA1c in the range of 5.0-5.4% was associated with the lowest all-cause mortality. The “normal” range of up to 5.7% includes values already associated with elevated risk.
Fasting insulin is often more revealing for early metabolic dysfunction. Optimal fasting insulin: <5 µIU/mL. Values in the 10-20 range (within “normal” for most labs) suggest insulin resistance that hasn't yet shown up in glucose or HbA1c.
For continuous glucose monitoring: Levels CGM is the most user-friendly option — connects to a CGM sensor and gives actionable feedback on your real-time glucose response to food.
4. High-Sensitivity CRP (hsCRP)
C-reactive protein measures chronic low-grade inflammation — the “inflammaging” process underlying most chronic disease.
- Low risk: <1.0 mg/L
- Moderate risk: 1.0-3.0 mg/L
- High risk: >3.0 mg/L
Note: CRP spikes acutely with infection or injury. Test when you're healthy and not recently sick. Key lifestyle drivers of elevation: obesity, smoking, sleep deprivation, ultra-processed food diet, sedentary behavior.
5. HOMA-IR (Insulin Resistance Calculation)
HOMA-IR is calculated from fasting insulin and fasting glucose: (Fasting Insulin × Fasting Glucose) / 405 (using mg/dL and µIU/mL).
- Optimal: <1.0
- Moderate resistance: 1.5-2.5
- Significant resistance: >2.5
6. Homocysteine
Elevated homocysteine is independently associated with cardiovascular disease, cognitive decline, and Alzheimer's risk. A 2018 meta-analysis in Nutrients (Smith & Refsum) found that elevated homocysteine (>14 µmol/L) more than doubles the risk of Alzheimer's disease.
- Optimal: <8-10 µmol/L
- Elevated: >12 µmol/L
Intervention: B vitamins — specifically B12, B6, and methylfolate — lower homocysteine efficiently. A 2010 RCT in PLoS ONE (Smith et al.) found B-vitamin supplementation in people with elevated homocysteine reduced brain atrophy by 53% over 2 years.
7. Testosterone (Free and Total) + SHBG
Relevant for both men and women. Testosterone is involved in muscle mass maintenance, insulin sensitivity, bone density, and cognitive function. SHBG (Sex Hormone Binding Globulin) determines how much testosterone is “free” (bioavailable). High SHBG can leave you with normal total testosterone but low free testosterone.
8. Ferritin
Ferritin is an iron storage protein. Low ferritin causes fatigue and impaired cognitive function. But high ferritin — particularly persistent elevation not explained by inflammation — is associated with increased cardiovascular disease and all-cause mortality risk (Zacharski et al., 2008, BMC Medicine). Optimal range: 50-150 ng/mL for most adults.
How to Approach Your Results
Don't just check boxes. Look at trends over time. A single measurement is a snapshot. Two measurements 6-12 months apart tell you which direction you're moving. Create your own spreadsheet: Date. ApoB. HbA1c. Fasting insulin. hsCRP. Homocysteine. Testosterone. Ferritin. Repeat annually at minimum.
Get your first comprehensive panel through Marek Health if you want a practitioner who will discuss optimal ranges rather than just flagging things outside the disease-diagnosis range. Your bloodwork is the most honest feedback loop you have.