Best At-Home Blood Tests for Longevity: Ranked by Biomarker Depth

Why Bloodwork Is the Foundation of Longevity Medicine#

You cannot optimise what you do not measure. This sounds obvious, but most people navigate decades of life with no idea what their ApoB, insulin, or homocysteine levels are — three biomarkers that are among the strongest predictors of cardiovascular events and cognitive decline.

Dr. Peter Attia calls comprehensive bloodwork "the most important thing you can do for your long-term health that doesn't involve lifestyle change." It tells you:

• What's already going wrong before symptoms appear
• Whether your interventions (supplements, diet, exercise) are working
• Your baseline, so future changes are meaningful

The 10 Biomarkers That Matter Most for Longevity#

1. ApoB (Apolipoprotein B)#

The single best marker of cardiovascular risk — better than LDL cholesterol. Every atherogenic particle (LDL, VLDL, IDL, Lp(a)) carries one ApoB protein. High ApoB = high particle count = high risk.

Optimal: under 70 mg/dL (Attia targets under 60 mg/dL for high-risk individuals) Why standard panels miss it: Most GPs only order LDL-C, which can be normal even when ApoB is elevated

2. Lp(a) — Lipoprotein(a)#

Genetically determined — you cannot diet or exercise it away. High Lp(a) is present in ~20% of the population and dramatically increases cardiovascular risk. You need to know your number.

Optimal: under 30 mg/dL (or under 75 nmol/L) Test once: It barely changes over a lifetime

3. Fasting Insulin#

Standard glucose tests can appear normal for years while insulin is chronically elevated — a sign of insulin resistance decades before diabetes. Fasting insulin under 6 µIU/mL is ideal; above 10 µIU/mL warrants action.

4. HbA1c#

3-month average of blood glucose. More stable than fasting glucose. Optimal for longevity: 4.8–5.2%. Many "normal" ranges extend to 5.7% — this is too permissive for longevity optimisation.

5. Homocysteine#

Elevated homocysteine is an independent risk factor for cardiovascular disease, stroke, and cognitive decline. Driven by B12, B6, and folate deficiency. Optimal: under 7 µmol/L.

6. hsCRP (High-sensitivity C-reactive protein)#

The best widely-available marker of systemic inflammation. Chronic low-grade inflammation drives atherosclerosis, neurodegeneration, and cancer. Optimal: under 0.5 mg/L.

7. Vitamin D (25-OH)#

Over 40% of adults are deficient. Low vitamin D is associated with increased all-cause mortality, poor immune function, and metabolic dysfunction. Test twice yearly. Optimal: 40–60 ng/mL.

8. Testosterone (Total + Free) & SHBG#

Declining testosterone is associated with metabolic syndrome, depression, and sarcopenia. You need total AND free testosterone (SHBG determines bioavailability). DHEA-S is an important adrenal marker often neglected.

9. Ferritin#

Iron overload is a major, underappreciated longevity risk — it generates free radicals. Optimal: 30–150 ng/mL. Many labs consider 300+ "normal" — it is not.

10. TMAO (Trimethylamine N-oxide)#

An emerging gut-microbiome-derived marker strongly linked to cardiovascular disease risk. Elevated TMAO (above 6 µM) suggests microbiome dysbiosis and/or high red meat/egg consumption.

Function Health — Best Overall#

Function Health was co-founded by Dr. Mark Hyman (Head of Strategy at Cleveland Clinic Center for Functional Medicine) and Jim Breyer. Their panel covers 160+ biomarkers — more than most concierge medicine practices offer.

What makes it exceptional:

• Includes Lp(a), ApoB, fasting insulin, homocysteine, TMAO, cortisol, and comprehensive thyroid panels — markers most "comprehensive" panels miss
• Results come with physician-written interpretations
• Year-over-year trending as you retest
• The $499/year subscription includes two full panels annually — $250/panel for 160+ biomarkers is extraordinary value

The limitation: There's currently a waitlist in some regions, and it's US-only.

How Often Should You Test?#

| Life Stage | Frequency | Focus | |------------|-----------|-------| | Under 30, healthy | Annually | Establish baseline | | 30–50 | Every 6 months | Track trends, optimise | | 50+ | Every 3–6 months | Monitor cardiovascular + metabolic | | Starting new interventions | 8–12 weeks after | Confirm effect |

The most important number isn't a single test result — it's the trend over years. A single ApoB of 90 mg/dL is concerning; ApoB trending from 110 → 90 → 75 over 18 months is success.