The Complete Longevity Blood Test Panel
ApoB, Lp(a), fasting insulin, HOMA-IR, hs-CRP, homocysteine, omega-3 index, hormones — the full Medicine 3.0 biomarker panel explained, with Australian context.
The Quick Answer
The longevity medicine movement — popularised by Peter Attia, Bryan Johnson, and the Huberman Lab podcast — is built on a simple idea: the diseases that kill most people (cardiovascular disease, type 2 diabetes, Alzheimer's, cancer) are detectable decades before symptoms appear. Standard GP blood tests catch late-stage disease. The longevity panel is designed to catch the earliest biochemical signals, when interventions are most effective.
The four most important additions beyond a standard GP panel are: ApoB (replaces LDL as the cardiovascular risk marker), fasting insulin (detects insulin resistance 10-15 years before HbA1c rises), hs-CRP (chronic inflammation driver of almost all chronic disease), and homocysteine (methylation and dementia risk). These four tests change clinical management more often than any other additions to a standard panel.
Why Standard GP Panels Miss the Biggest Risks
A standard Australian GP health check typically includes: full blood count, fasting glucose, lipids (total cholesterol, LDL, HDL, triglycerides), liver function tests, kidney function, and thyroid. This is excellent for detecting established disease but has major blind spots for early prevention.
LDL cholesterol is a poor cardiovascular predictor in people with metabolic syndrome or small dense LDL particles. You can have an LDL of 2.5 mmol/L and an ApoB of 1.4 g/L — meaning a high particle burden despite a “normal” LDL. Up to 30% of people who have heart attacks have LDL below 3.0 mmol/L.
Fasting glucose and HbA1c do not detect insulin resistance until late in its progression. A person with a fasting glucose of 5.2 mmol/L and HbA1c of 37 mmol/mol can have a fasting insulin of 25 mIU/L and a HOMA-IR of 5.8 — clinically significant insulin resistance that will not show on a standard panel for another decade.
The Longevity Biomarker Panel — All 14 Markers
Markers are grouped by the system they track. Longevity targets are more ambitious than standard lab reference ranges — they represent optimal function, not just the absence of disease.
ApoB (Apolipoprotein B)
Counts every atherogenic particle. The single best predictor of cardiovascular events — better than LDL cholesterol.
Longevity target: Below 0.8 g/L for general population; below 0.6 g/L with established CVD or high risk.
Australian range: Standard lab: 0.52-1.63 g/L. Longevity target: <0.8 g/L.
Lp(a) (Lipoprotein(a))
Genetic cardiovascular risk factor. Test once in a lifetime. Elevated Lp(a) triples MI risk independent of LDL.
Longevity target: Below 50 mg/dL (125 nmol/L). Above this is high risk; largely unmodifiable by lifestyle.
Australian range: Low risk: <30 mg/dL; Borderline: 30-50 mg/dL; High: >50 mg/dL
Fasting Insulin
Earliest marker of insulin resistance — rises 10-15 years before glucose. High insulin drives cancer, CVD, and Alzheimer's risk.
Longevity target: Below 6 mIU/L fasting. Above 12 mIU/L is concerning; above 20 mIU/L is significant insulin resistance.
Australian range: Standard: 2-25 mIU/L. Longevity optimal: <6 mIU/L fasting.
HOMA-IR
Calculated from fasting insulin and glucose. Quantifies insulin resistance more precisely than either marker alone.
Longevity target: Below 1.0 is optimal. Above 2.0 indicates clinically significant insulin resistance.
Australian range: Not a standard lab test — calculated: (insulin mIU/L x glucose mmol/L) / 22.5
HbA1c (Haemoglobin A1c)
Average blood glucose over 3 months. Early diabetes and pre-diabetes detection. Medicare item 66536.
Longevity target: Below 35 mmol/mol (5.4%) is optimal longevity range. Pre-diabetes: 39-47 mmol/mol.
Australian range: Normal: <42 mmol/mol (6.0%); Pre-diabetes: 42-47; Diabetes: ≥48 mmol/mol
hs-CRP (High-Sensitivity CRP)
Low-grade chronic inflammation marker. Elevated hs-CRP predicts cardiovascular events, cancer, and accelerated ageing independently of other markers.
Longevity target: Below 0.5 mg/L is optimal. Above 3 mg/L is high cardiovascular risk (excluding acute infection).
Australian range: Low risk: <1 mg/L; Moderate: 1-3 mg/L; High: >3 mg/L
Homocysteine
Amino acid that damages arterial walls when elevated. Marker of B-vitamin status (B6, B9, B12). Raised homocysteine doubles dementia risk.
Longevity target: Below 10 µmol/L is optimal. Above 15 µmol/L is hyperhomocysteinaemia needing treatment.
Australian range: Normal: 5-15 µmol/L. Longevity target: <10 µmol/L.
Omega-3 Index (EPA + DHA)
Measures red cell EPA + DHA content — reflects average omega-3 intake over 3-4 months. Below 4% = high cardiovascular risk.
Longevity target: Above 8% is the evidence-based target. The average Australian sits below 5%.
Australian range: High risk: <4%; Intermediate: 4-8%; Optimal: >8%
Vitamin D (25-OH)
Deficiency impairs immune function, muscle strength, bone density, mood, and insulin sensitivity. Common in office-working Australians despite sunny climate.
Longevity target: 75-125 nmol/L. Below 50 nmol/L is deficiency; above 150 nmol/L risks hypercalcaemia.
Australian range: Deficiency: <50 nmol/L; Sufficiency: 50-150 nmol/L. Medicare rebatable (item 66608).
Ferritin (Iron Stores)
Low ferritin causes fatigue, poor exercise performance, hair loss. Very high ferritin (above 300 in men) suggests haemochromatosis or chronic inflammation.
Longevity target: Optimal: 50-150 µg/L. Women: 30-100 µg/L pre-menopause. Above 300 µg/L warrants investigation.
Australian range: Men: 30-400 µg/L; Women: 13-150 µg/L (RCPA). Optimal longevity: 50-150 µg/L.
Testosterone (Total & Free)
Declines 1-2% per year after age 30 in men. Low testosterone drives sarcopenia, depression, cardiovascular risk, and cognitive decline.
Longevity target: Total testosterone above 15 nmol/L in men; free testosterone above 225 pmol/L. Women: 0.5-2.5 nmol/L.
Australian range: Men total: 9-38 nmol/L. Women total: 0.3-1.7 nmol/L (RCPA ranges).
IGF-1 (Insulin-like Growth Factor 1)
Growth hormone surrogate. Both very low and very high IGF-1 associate with increased mortality — a U-shaped curve. Reflects protein intake and GH axis.
Longevity target: Mid-range for age. In adults 40-60: approximately 100-200 µg/L. Very high IGF-1 may increase cancer risk.
Australian range: Age-dependent. Adults 30-50: 90-250 µg/L (lab-specific, highly age-dependent).
TSH & Free T3
Thyroid dysfunction — both hypo and hyperthyroidism — accelerates cardiovascular risk and metabolic dysfunction. TSH alone can miss subclinical cases.
Longevity target: TSH: 1.0-2.5 mIU/L is the longevity sweet spot within the normal range. Free T3 in the upper half of the normal range.
Australian range: TSH: 0.3-4.5 mIU/L (RCPA). Free T3: 3.5-6.5 pmol/L.
GGT (Gamma-Glutamyl Transferase)
Sensitive marker of liver stress, alcohol use, fatty liver, and oxidative stress. High GGT predicts cardiovascular events independently of other markers.
Longevity target: Below 20 U/L is optimal. Above 40 U/L in men (30 in women) warrants investigation.
Australian range: Men: 10-71 U/L; Women: 6-42 U/L. Longevity optimal: <20 U/L.
What Suboptimal Biomarkers Feel Like
Many people assume that feeling “fine” means their markers are optimal. The relationship between biomarkers and symptoms is more complex — most metabolic risk accumulates silently. These are the symptoms that longevity biomarkers often explain.
High ApoB with no symptoms
The most dangerous pattern in preventive medicine. Atherosclerosis is silent for decades. By the time a first heart attack occurs, 70-80% of people had no prior symptoms. ApoB is an early warning sign that acts before symptoms start.
Fatigue and low energy
Non-specific but important. Could indicate low ferritin (iron stores), vitamin D deficiency, hypothyroidism (high TSH), low testosterone, insulin resistance (high HOMA-IR), or B12 deficiency. A full panel rapidly narrows the cause.
Brain fog and poor concentration
Elevated homocysteine, insulin resistance, vitamin D deficiency, low free T3, and suboptimal omega-3 index all impair cognitive function. Optimising these markers is associated with better memory and processing speed.
Loss of muscle mass (sarcopenia)
Driven by low testosterone, high cortisol, insulin resistance, low IGF-1, and inadequate protein intake. Muscle mass is the single strongest predictor of longevity and independence in older age.
Central weight gain (abdominal adiposity)
Visceral fat is metabolically active. It drives insulin resistance (high HOMA-IR), inflammation (high hs-CRP), and high oestrogen in men. The combination of waist circumference above 90 cm (men) or 80 cm (women) with high fasting insulin is a core metabolic syndrome pattern.
Poor sleep and mood changes
Hormonal imbalance (low testosterone, high cortisol), suboptimal thyroid function, vitamin D deficiency, and high hs-CRP all contribute to insomnia, depression, and anxiety. Treating the underlying biochemistry often improves symptoms without medication.
Frequent illness or slow recovery
Chronic low-grade inflammation (high hs-CRP), low vitamin D, suboptimal omega-3 index, and iron deficiency all impair immune function. Recurrent infections warrant investigation of these markers.
High blood pressure
Hypertension in the context of longevity medicine is often driven by high insulin (promoting renal sodium retention), high homocysteine (arterial stiffness), and low omega-3 (higher vascular tone). Address these markers first before assuming medication is the only option.
Metabolic Red Flags — When to Act Urgently
These findings warrant prompt GP review and active intervention — not a “wait and see” approach:
ApoB above 1.3 g/L
Substantially elevated cardiovascular particle burden. This places you in a risk category where statin therapy is generally indicated regardless of LDL level. Discuss with your GP the benefits of high-intensity statin therapy and a dietary strategy to reduce ApoB below 0.8 g/L.
Fasting insulin above 20 mIU/L or HOMA-IR above 3.0
Significant insulin resistance. This drives atherosclerosis, increases cancer risk (particularly breast, colon, endometrial), and is the core biochemical defect in pre-diabetes and metabolic syndrome. Requires urgent lifestyle intervention: low-glycaemic-index diet, resistance training, weight loss if applicable.
hs-CRP persistently above 3 mg/L (excluding acute illness)
High-grade chronic inflammation. Doubles cardiovascular risk. Rule out infection, autoimmune disease, or sleep apnoea as causes. Interventions: omega-3 supplementation, anti-inflammatory diet (Mediterranean), statins (which have anti-inflammatory pleiotropic effects beyond LDL reduction), and aerobic exercise.
Homocysteine above 20 µmol/L
Severe hyperhomocysteinaemia. Associated with accelerated atherosclerosis, venous thromboembolism, and a 2-3 fold increase in dementia risk. Treat with high-dose methylated B vitamins (methylfolate 1-5 mg + methylcobalamin 1-2 mg + B6 50-100 mg daily). Recheck at 6 weeks.
Testosterone below 8 nmol/L (men) with symptoms
Clinical hypogonadism. Associated with sarcopenia, cardiovascular risk, depression, osteoporosis, and erectile dysfunction. Requires endocrinologist review. Testosterone replacement therapy (TRT) is a recognised treatment and is PBS-subsidised in Australia for documented hypogonadism.
Vitamin D below 30 nmol/L
Severe deficiency. At this level, calcium absorption falls, PTH rises (secondary hyperparathyroidism), and bone loss accelerates. Associated with immune dysfunction, muscle weakness, and falls risk. Requires loading dose (50,000 IU/week for 8 weeks) followed by maintenance supplementation.
How and When to Get Tested
The longevity panel requires more than a routine 10-minute GP visit. Plan for a long consultation and be prepared to self-fund some of the less mainstream markers.
Annual full longevity panel
Once a year: ApoB, Lp(a) if not done before, HbA1c, fasting insulin, HOMA-IR, hs-CRP, homocysteine, vitamin D, ferritin, full lipid panel, ALT, GGT, creatinine, cystatin C, TSH, free T3, testosterone (total and free), oestradiol, DHEA-S, IGF-1, omega-3 index, B12, and folate. This is 20-25 tests. Some require fasting (insulin, glucose, lipids). Book a morning appointment, fast from 10pm the night before.
6-monthly for key metabolic markers
If you are actively working to improve a specific metric — reducing ApoB with statins or diet, lowering HbA1c, reducing hs-CRP, or optimising HOMA-IR — recheck those specific markers every 6 months to confirm the intervention is working. You cannot improve what you do not measure.
Lp(a) once in a lifetime
Lp(a) is 90% genetically determined and does not change meaningfully with lifestyle. Have it measured once between ages 20-40. If it is high (>50 mg/dL), this is important prognostic information that affects cardiovascular risk stratification for life, but does not require repeat testing.
Hormone panel with age-matched interpretation
Testosterone, oestradiol, DHEA-S, and IGF-1 are highly age-dependent. A total testosterone of 12 nmol/L is normal for a 75-year-old but suboptimal for a 40-year-old. Always compare against age-matched reference ranges. Consider retesting 6 weeks after any hormone-related intervention to confirm response.
Omega-3 Index every 12-18 months
The omega-3 index responds slowly — it takes 3-6 months of supplementation to see a meaningful rise. Once you are stable on a supplement dose, annual testing is sufficient. Aim to spend as much time as possible above 8%.
Continuous glucose monitor (CGM) for metabolic insight
A CGM worn for 14 days gives information that no static blood test can: postprandial glucose spikes, time-in-range, glucose variability. This is the most powerful tool for understanding how specific foods affect your blood sugar. Abbott Libre and Dexone are available in Australia. Combine CGM data with fasting insulin from your annual blood panel.
Discuss results with a GP experienced in preventive medicine
A standard GP consult is 10-15 minutes — not enough for a 25-marker longevity panel. Book a long consultation (45-60 min). GPs with an interest in metabolic health, sports medicine, or preventive medicine are best placed to interpret these results in context. Ask for a referral to an endocrinologist if hormonal findings are complex.
Evidence-Based Interventions That Move the Markers
These are the interventions with the strongest evidence base for improving longevity biomarkers in Australian adults. They are ordered by impact, not ease.
Zone 2 cardio: 3-4 hours per week
CardiovascularZone 2 is the most powerful single intervention for metabolic health. Defined as the highest exercise intensity at which you can hold a conversation. It improves mitochondrial density, insulin sensitivity, and lipid oxidation. 3-4 hours per week is the minimum effective dose endorsed by Peter Attia and longevity researchers.
Resistance training: 3x per week
Muscle and hormonesMuscle mass is the single strongest predictor of longevity and independence. Resistance training raises testosterone, improves insulin sensitivity, increases DHEA-S, and lowers hs-CRP. Compound movements (squat, deadlift, press) 3 times per week is more effective than any supplement.
Time-restricted eating (12-16 hour fast)
MetabolicExtending overnight fasting to 14-16 hours (eating within an 8-10 hour window) lowers fasting insulin, reduces HOMA-IR, and modestly reduces hs-CRP. The effect is equivalent to a 10-15% calorie reduction for most people without explicit calorie counting.
Omega-3: 2-4 g EPA+DHA per day
InflammationThe therapeutic dose for raising the omega-3 index above 8% and reducing hs-CRP is 2-4 g/day of combined EPA+DHA. This requires a quality fish oil supplement (not a 1 g capsule, which is typically only 30-60% EPA+DHA). CSIRO research supports omega-3 as reducing cardiovascular risk in Australian adults.
Vitamin D: 2000-5000 IU/day if below 75 nmol/L
NutritionalMost indoor-working Australians need supplementation. The optimal maintenance dose is 2000-3000 IU/day, reaching 75-125 nmol/L in most adults. Take with a meal containing fat (D3 is fat-soluble). Recheck at 3 months after starting or changing dose.
Mediterranean diet with extra olive oil
DietThe PREDIMED trial (7447 participants) showed a Mediterranean diet supplemented with extra-virgin olive oil reduced cardiovascular events by 30% over 5 years — greater than many medications. This directly improves ApoB, hs-CRP, and insulin sensitivity. It is the most evidence-based dietary pattern for longevity.
Sleep: 7-9 hours with good quality
FoundationalSleep deprivation below 6 hours raises hs-CRP, cortisol, fasting glucose, and insulin within days. It also lowers testosterone by 10-15%. No supplement or exercise protocol compensates for inadequate sleep. Treat sleep apnoea aggressively — it is one of the strongest drivers of high hs-CRP and insulin resistance in Australian adults.
Methylated B vitamins if homocysteine is elevated
Targeted supplementationIf homocysteine is above 10 µmol/L, methylated forms are significantly more effective than standard cyanocobalamin B12 and folic acid: methylcobalamin B12 (500-1000 µg/day), methylfolate (400-1000 µg/day), and P5P (pyridoxal-5-phosphate, the active B6 form, 25-50 mg/day). Recheck homocysteine at 8 weeks.
Related Reading
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This page provides general educational information about longevity biomarkers and preventive health testing. Longevity targets are aspirational ranges based on current research and may differ from your treating doctor's recommendations for your specific circumstances. Always consult a GP or specialist before starting, changing, or stopping any medication, hormone, or supplement based on blood test results. SmarterBlood does not provide medical care.