2024NEJM
Ridker et al.
27,939 women, 30 years
Women in the top fifth for hsCRP had 70% higher heart risk; for LDL 36% and for Lp(a) 33%. Measuring all three gave the clearest picture.
Find on PubMed ↗Research library · Hormones & inner health
Longevity biomarkers: the blood tests that matter
A standard check-up misses some of the strongest predictors of heart attacks and ageing. ApoB, lipoprotein(a) and high-sensitivity CRP add real information, and new AI 'ageing clocks' hint at how fast your organs are ageing.
Good evidence+70%30-year heart risk in women with the highest inflammation (hsCRP)Ridker 2024, NEJM, 27,939 women
1 in 5people inherit high lipoprotein(a); one test in your life finds itKronenberg 2022, Eur Heart J (EAS consensus)
45kadults' blood proteins used to build an AI 'ageing clock' that predicts 18 diseasesArgentieri 2024, Nat Med, UK Biobank
01
The basics
Beyond 'your cholesterol is fine'
Cholesterol travels in particles. Every particle that can clog arteries (LDL, VLDL, remnants, Lp(a)) carries exactly one ApoB protein, so ApoB counts the number of harmful particles. When LDL cholesterol and ApoB disagree, ApoB predicts risk better.
Lipoprotein(a), or Lp(a), is a sticky particle set by your genes. Diet and exercise barely change it, but knowing you're high means treating other risks harder. hsCRP measures low-grade inflammation, which drives heart disease alongside cholesterol.
Researchers now use AI to build ageing clocks from DNA methylation or thousands of blood proteins. They predict disease and death in large groups, but consumer tests vary between labs and aren't yet precise enough to guide personal treatment.
ApoB counts the particles that clog arteries
Each harmful cholesterol particle carries one ApoB. More particles means more chances for one to slip into the artery wall and start a plaque.
02
How it works
From blood test to action
1
Blood sample
Most of these tests don't need fasting.
2
Particles counted
ApoB and Lp(a) show how many artery-clogging particles you carry.
3
Inflammation read
hsCRP shows low-grade inflammation in the body.
4
Risk you can act on
Results guide diet, exercise and, if needed, medicines.
03
Measure it
An extended longevity panel
- ApoB: ideally under 80–90 mg/dL for most people, lower if you're at high risk.
- Lp(a): test once. Above about 50 mg/dL (≈125 nmol/L) is considered high.
- hsCRP: under 1 mg/L is low risk, 1–3 average, over 3 high. Repeat if high, since a cold can raise it.
- Also useful: HbA1c, kidney function with cystatin C, liver enzymes (ALT, GGT), ferritin, vitamin D and a full blood count.
Try your number
OptimalBorderlineHighVery high
40160
European (ESC/EAS 2019) goals: under 100 mg/dL at moderate risk, under 80 at high risk, under 65 at very high risk.
04
What the research says
The key studies
2022European Heart Journal
Kronenberg et al.
European Atherosclerosis Society consensus
Everyone should have Lp(a) measured at least once; about 20% of people have levels that raise heart and valve disease risk.
Find on PubMed ↗2019JAMA Cardiology
Sniderman et al.
Review of genetic and trial data
The number of ApoB particles, more than the cholesterol inside them, drives artery disease.
Find on PubMed ↗2024Nature Medicine
Argentieri et al.
45,441 UK Biobank adults
A protein-based ageing clock predicted 18 major diseases and death, and worked in Chinese and Finnish groups too.
Find on PubMed ↗2023Nature
Oh et al.
5,678 adults
Blood proteins showed that about 1 in 5 people had one organ ageing much faster. A fast-ageing heart signalled 2.5 times the risk of heart failure.
Find on PubMed ↗2023Nature Aging
Waziry et al. (CALERIE)
220 adults, 2 years
Eating about 12% fewer calories slowed the DunedinPACE ageing clock by 2–3%.
Find on PubMed ↗05
Take action
Using your numbers
One extra set of tests can change your plan for decades.
- 1
Ask for ApoB and Lp(a)
They're cheap, widely available and add to a standard cholesterol test.
- 2
Check hsCRP twice
Do it when you're well; average two results taken weeks apart.
- 3
Track trends yearly
Changes over time tell you more than a single result.
- 4
Treat high numbers early
Lowering ApoB earlier in life prevents more disease. Discuss statins or other options with a doctor.
- 5
Lower ApoB with food
More fibre, nuts, beans and olive oil; less saturated fat from butter, fatty meat and pastries.
- 6
Be wary of ageing-clock kits
Interesting, but the same sample can give different 'ages' at different labs.
06
Myth or fact
Common myths, checked
✕ MythNormal total cholesterol means no risk.
✓ FactYou can have normal cholesterol but a high particle count (ApoB) or high Lp(a).
✕ MythYou can fix Lp(a) with diet.
✓ FactIt's mostly genetic. New drugs that lower it are in large trials; meanwhile, treat other risk factors harder.
✕ MythEpigenetic age tests are precise.
✓ FactThey're useful in research groups but can vary by years for one person between tests.
✕ MythHigher HDL is always better.
✓ FactVery high HDL has been linked to higher death risk in some studies. ApoB matters more.
07
Questions
Frequently asked
Do I need to fast?
Usually not for ApoB, Lp(a) or hsCRP. Triglycerides and glucose are more accurate fasting.
How often should I test?
Lp(a) once. ApoB and hsCRP every 1–5 years depending on your risk and results.
What if my doctor won't order them?
Explain your family history. ApoB and Lp(a) are recommended in European and some US guidelines.
08
Sources
References and related topics
- Ridker et al. (2024). NEJM. 27,939 women, 30 years. PubMed ↗
- Kronenberg et al. (2022). European Heart Journal. European Atherosclerosis Society consensus. PubMed ↗
- Sniderman et al. (2019). JAMA Cardiology. Review of genetic and trial data. PubMed ↗
- Argentieri et al. (2024). Nature Medicine. 45,441 UK Biobank adults. PubMed ↗
- Oh et al. (2023). Nature. 5,678 adults. PubMed ↗
- Waziry et al. (CALERIE) (2023). Nature Aging. 220 adults, 2 years. PubMed ↗