What blood tests matter most for longevity?

There is no standard longevity panel

Longevity panel is a marketing term, not a medical standard. US guidance is written test by test and condition by condition, and for some popular markers, such as vitamin D and thyroid hormones, the US Preventive Services Task Force (USPSTF) finds the evidence too limited to assess the benefits and harms of routine screening in adults without symptoms.

Blood tests are also only part of the picture. The American Heart Association's Life's Essential 8 score combines diet, physical activity, nicotine exposure, sleep, body mass index, blood pressure, non-HDL cholesterol and blood glucose. In a study of 23,003 US adults from the National Health and Nutrition Examination Survey, people with high scores (80 or more) had an estimated 8.9 more years of life expectancy at age 50 than people with low scores (below 50). Only two of those eight measures come from a blood test. The rest come from daily habits, body size and blood pressure.

Lipids and hs-CRP: heart risk

The 2019 ACC/AHA primary prevention guideline lists these lipid results as risk-enhancing factors, which help confirm a higher risk of heart attack and stroke in the discussion with your clinician:

• LDL cholesterol of 160 to 189 mg/dL, or non-HDL cholesterol of 190 to 219 mg/dL.
• Triglycerides that stay at 175 mg/dL or more.
• Metabolic syndrome, diagnosed from any three of: a large waist, triglycerides above 150 mg/dL, raised blood pressure, raised glucose, and HDL below 40 mg/dL in men or below 50 mg/dL in women.

The same guideline treats hs-CRP as optional. If it is measured, a level of 2.0 mg/L or more counts as a risk-enhancing factor and feeds into the same risk discussion, rather than standing alone as a screening test.

HbA1c: blood sugar and diabetes risk

HbA1c is one of the standard tests used to screen for and diagnose diabetes. Under the American Diabetes Association's 2026 Standards of Care, an HbA1c of 5.7% to 6.4% is in the prediabetes range and 6.5% or above is in the diabetes range.

The ADA advises screening for everyone from age 35, and at any age for adults with overweight or obesity plus one or more risk factors. If results are normal, repeating at least every 3 years is reasonable. Blood glucose is also one of the Life's Essential 8 measures.

Kidney function

Kidney disease often goes unnoticed. The CDC notes that there are often no symptoms until the kidneys are badly damaged, and that diabetes and high blood pressure raise the risk. Kidney function is checked with blood tests, including serum creatinine and the glomerular filtration rate (GFR), and a urine test for albumin. A urine albumin result of 30 or above may mean kidney disease.

Kidney health and heart health are linked. The 2019 ACC/AHA guideline lists chronic kidney disease, with an eGFR of 15 to 59 mL/min/1.73 m2, as a risk-enhancing factor for heart disease.

Liver enzymes: ALT and AST

ALT and AST are liver enzymes. The American Association for the Study of Liver Diseases (AASLD) notes that the most common causes of death in people with non-alcoholic fatty liver disease are cardiovascular disease and cancers outside the liver, followed by liver disease, and that insulin resistance is nearly universal in the condition. That is why liver results belong in a metabolic health check, not just a liver one.

Liver enzymes have limits. The AASLD notes that AST can be normal even in people with diabetes or advanced liver scarring, and that ALT or AST above 30 U/L, either on and off or for 6 to 12 months or more, may suggest chronic liver injury. That threshold is below the upper limit most labs use. For people with fatty liver and two or more metabolic risk factors, especially prediabetes or type 2 diabetes, the AASLD advises a FIB-4 score every 1 to 2 years. FIB-4 is calculated from age, ALT, AST and platelet count.

Vitamin D and thyroid: test with a reason

Vitamin D and TSH are popular add-ons, but the evidence for routine screening is thin. In 2021 the USPSTF concluded that the evidence is insufficient to assess the benefits and harms of screening for vitamin D deficiency in adults without symptoms. It also noted that no one blood level defines deficiency and that there is no consensus on the level that represents optimal health.

For thyroid disease, the USPSTF reached the same conclusion in 2015 for nonpregnant adults without symptoms. TSH is the primary screening test, and the USPSTF notes that abnormal findings should be confirmed with repeat tests over 3 to 6 months. Both tests are useful when a doctor has a reason to order them, such as symptoms or a known risk.

Markers a doctor may add: ApoB, Lp(a) and fasting insulin

The 2019 ACC/AHA guideline names two extra lipid tests and when they help:

• ApoB: a level of 130 mg/dL or more is a risk-enhancing factor and corresponds to an LDL above 160 mg/dL. The guideline gives triglycerides of 200 mg/dL or more as a relative reason to measure it.
• Lp(a): a level of 50 mg/dL or more is a risk-enhancing factor, especially at higher levels. The guideline gives a family history of early heart disease as a relative reason to measure it.
• Fasting insulin: MedlinePlus says the main reason for insulin testing is to find the cause of low blood glucose, and that the test is not usually used to diagnose diabetes. It can be combined with other tests to assess insulin resistance, and reference ranges vary between labs.

Speak to your doctor about which of these suit you, especially if you have a family history of early heart disease, diabetes or high cholesterol. Any out-of-range result should be interpreted by a doctor alongside your blood pressure, history and lifestyle.