The Longevity Stack Checklist

The number of LDL and VLDL particles in circulation — a better predictor of cardiovascular risk than LDL cholesterol alone. Each ApoB molecule represents one atherogenic particle capable of penetrating arterial walls. Replaces "LDL-C" as the primary lipid target in longevity medicine. Not included in standard lipid panels; request as an add-on.

An LDL-like particle with an additional apolipoprotein(a) protein that makes it particularly atherogenic and prothrombotic. Levels are 80–90% genetically determined and poorly responsive to lifestyle. High Lp(a) (>50 mg/dL or >125 nmol/L) requires more aggressive treatment of all other modifiable risk factors. Test once — it doesn't change meaningfully over time.

Reflects average blood glucose over the prior 90 days. In longevity medicine, the target is not merely "non-diabetic" (<6.5%) but truly optimal (<5.3%). Each 1% rise in HbA1c above 5.0% is associated with a 15–28% increase in cardiovascular risk. Note: HbA1c can be falsely low in people with high RBC turnover or supplementing iron — combine with fasting glucose and fasting insulin for a complete picture.

The most sensitive early indicator of insulin resistance — detects metabolic dysfunction years before HbA1c or fasting glucose becomes abnormal. Standard labs flag values up to 25 µIU/mL as "normal"; longevity-focused physicians target <6, with truly metabolically healthy individuals below 5. Elevated fasting insulin drives accelerated aging via mTORC1 activation, inflammation, and visceral fat accumulation.

Both low and high ferritin drive poor outcomes. Low ferritin causes fatigue, cognitive impairment, and impaired thyroid function — extremely common in premenopausal women. High ferritin (>150–200 ng/mL in women, >200 in men) is an independent predictor of metabolic syndrome and may drive oxidative stress via Fenton reactions. Also used as an acute-phase reactant — elevated ferritin can indicate inflammation even when iron stores are adequate.

Testosterone declines 1–2% per year after 30 in men. Below 400 ng/dL total (or 10–15 pg/mL free) is associated with increased visceral adiposity, insulin resistance, muscle loss, cardiovascular risk, and cognitive decline. Measure total testosterone (fasted, 7–10 AM when levels peak) AND free testosterone (since SHBG rises with age, binding more total T). Women need testosterone too: optimal free T in women is 1–3 pg/mL.

The most abundant circulating steroid hormone and a direct precursor to testosterone and estrogen. DHEA-S peaks in the mid-20s and declines to 10–20% of peak levels by age 70–80. Low DHEA-S is associated with depression, reduced immune function, and increased all-cause mortality in multiple longitudinal studies. Levels vary widely by individual — testing is essential before any supplementation consideration.

The primary mediator of growth hormone signaling. Complex longevity relationship: too low impairs muscle maintenance and cognitive function; too high (chronically elevated via GH therapy or anabolic compounds) is associated with increased cancer risk via mTOR/PI3K pathway activation. The Goldilocks zone for longevity appears to be 120–200 ng/mL — optimized naturally via resistance training, adequate protein, and quality sleep (which drives GH release).

The most accessible marker of systemic low-grade inflammation — the central driver of accelerated aging ("inflammaging"). Standard lab ranges flag anything under 3.0 mg/L as normal; longevity medicine targets under 0.5 mg/L. Chronically elevated hs-CRP (>1.0 mg/L without acute illness) should trigger investigation: sleep quality, gut permeability, metabolic health, periodontal disease, and hidden infections are common drivers.

An amino acid intermediate in methionine metabolism. Elevated homocysteine (>10 µmol/L) is an independent risk factor for cardiovascular disease, stroke, and cognitive decline — and a direct marker of B-vitamin (B6, B12, folate) status and methylation capacity. Highly responsive to supplementation: 400–800mcg methylfolate + methylcobalamin + P5P (active B6) typically normalizes elevated levels within 90 days. Test everyone taking metformin, PPIs, or a vegan diet.

The storage form of Vitamin D, reflecting total body status. Standard labs flag deficiency at <20 ng/mL; longevity medicine targets 40–70 ng/mL based on immune, bone, and cancer risk data. Test twice per year (peak of winter, peak of summer) to calibrate your D3 supplementation dose. Do not exceed 100 ng/mL without medical supervision — toxicity risk increases above this threshold.

EPA + DHA as a percentage of total red blood cell fatty acids — a 3-month snapshot of your omega-3 status that's a stronger cardiovascular predictor than serum omega-3 levels. An omega-3 index below 4% is associated with a 10-fold increase in sudden cardiac death risk compared to levels above 8%. Most US adults test at 4–5%. Correct with 2–4g/day EPA+DHA in triglyceride form. OmegaQuant offers a validated home test kit.