10 Longevity Factors You Need to Know
Disclaimer: Not Medical Advice. Opinions are my own.
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Today's Newsletter at a Glance:
- Building Your Health Baseline
- Cardiovascular Biomarkers
- Metabolic Biomarkers
- Cancer Screening
The first step in prevention is knowing where you stand today.
You must establish a health baseline.
Looking good in the mirror doesn't always mean you're healthy.
Objective health data lets you make health decisions and track progress over time.
Here are the ten longevity factors I think everyone should know, what they tell you, and why they matter.
ApoB: Count the Particles, Not Just the Cholesterol
ApoB (apolipoprotein B) is a protein found on every particle that can build plaque in your arteries: LDL, VLDL, IDL, and Lp(a). Each of those particles carries exactly one ApoB, so this test is essentially a head count of the particles that cause arterial disease.
Your standard LDL cholesterol number measures how much cholesterol those particles carry. It doesn't tell you how many particles there are. ApoB is the better predictor of heart attack and stroke.
This matters most if you have diabetes, high triglycerides, or metabolic syndrome. In those situations, you may see a "normal" LDL alongside a high particle count. That person is told they're fine when they are not.
The good news: ApoB is an inexpensive test, and it doesn't require fasting. The 2026 U.S. cholesterol guideline now gives ApoB a bigger role in assessing risk.
Triglycerides and VLDL: The Overlooked Risk
Triglycerides are fats in your blood.
VLDL and its leftover "remnant" particles are what carry them around.
Strong genetic and clinical evidence ties high triglycerides and remnant particles directly to heart attack, stroke, and narrowing of the aortic valve.
Particle for particle, remnants may be even more harmful than LDL.
This is one of the most responsive numbers on your lab report.
Cutting back on refined carbs, sugar, and alcohol, losing weight, and exercising can decrease it substantially.
Lp(a): The Genetic Risk Most People Have Never Heard Of
Lp(a), pronounced "L-P-little-a," is a cholesterol particle whose level is more than 90% determined by your genes. It stays fairly stable throughout life, though levels can rise after menopause.
High Lp(a) is likely a direct cause of heart attack and aortic valve stenosis. Risk becomes clinically important above about 50 mg/dL (roughly 125 nmol/L, depending on the lab) and keeps climbing from there.
About 1 in 5 people have elevated Lp(a). Most of them have no idea.
Current National Lipid Association and the ESC/EAS 2025 recommend checking it at least once in every adult.
No drug is approved specifically to lower Lp(a), so if yours comes back high, controlling your other risk factors becomes even more important.
A1c, Fasting Glucose and Fasting Insulin: Catching Diabetes Early
What they are:
- Hemoglobin A1c reflects your average blood sugar over the past 2–3 months.
- Fasting glucose is a single snapshot of your blood sugar in the morning.
- Fasting insulin shows how hard your pancreas is working to keep glucose levels normal.
Diabetes roughly doubles your cardiovascular risk, and prediabetes is linked to higher death rates overall. Heart risk starts rising at A1c levels as low as about 5.5%, which is still technically “normal.”
Fasting insulin is the early warning system.
It can reveal insulin resistance years before your glucose or A1c drifts out of range, and that window is the best time to act.
Results vary between labs, so track your own trend using the same lab.
Liver Enzymes (ALT, AST, GGT)
These are blood markers of liver stress or injury, and they’re part of most routine lab panels.
Today, the most common cause of mildly elevated liver enzymes is fatty liver disease driven by metabolism. You may have heard it called nonalcoholic fatty liver disease (NAFLD); the current name is Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). It affects about 1 in 3 adults.
Fatty liver rarely travels alone. It goes hand in hand with insulin resistance, belly fat, and abnormal cholesterol. It raises the risk of heart disease, kidney disease, liver scarring, and several cancers.
Alcohol, some medications, and viral hepatitis can also raise these enzymes. So can a hard workout, since AST and ALT also come from muscle, so skip heavy training for a couple of days before your labs. Either way, an abnormal result deserves a closer look.
Interestingly, low GGT levels have been linked to reaching age 100.
hsCRP: Measuring Hidden Inflammation
High-sensitivity C-reactive protein is a sensitive blood marker of low-grade, body-wide inflammation.
Chronic inflammation drives arterial disease, diabetes, and some cancers. Below 1 mg/L is considered low risk and above 3 mg/L is high risk. People with the highest hsCRP levels have about 75% higher risk of death from any cause than those with the lowest.
One caution: a recent cold, injury, or infection can temporarily spike it. A level above 10 mg/L usually points to an acute illness. If yours is high, repeat it when you’re feeling well before drawing conclusions.
hsCRP is typically a downstream marker of poor metabolic health, higher levels of visceral fat, and insulin resistance.
Exercise, weight loss, not smoking, and a healthy diet all bring it down.
Home Blood Pressure: Use the 7-2-2 Rule
A single blood pressure reading in a doctor’s office is a snapshot, and often a misleading one. Home readings predict your risk better, and the 2025 blood pressure guideline recommends them.
Here's the routine I recommend:
- 7 days in a row
- 2 times a day (morning and evening)
- 2 readings each time, about 1 minute apart
That’s 28 readings. Average all of them instead of eyeballing the list. For most adults, the goal is an average under 130/80.
How to do it right:
- Use a validated upper-arm cuff (not a wrist cuff).
- Sit quietly for 5 minutes first, back supported, feet flat, arm resting at heart level.
- Take your morning readings before medications, coffee, or breakfast.
- Bring the blood pressure log or the device itself to your next doctor's visit.
High blood pressure is a leading cause of stroke, heart attack, heart failure, and kidney disease, and a major risk factor for dementia.
Home monitoring also catches two things an office visit misses: "white-coat" hypertension (high only at the doctor's office) and "masked" hypertension (normal in the office, high at home).
Quitting Smoking: The Biggest Win Available
Quitting means stopping all tobacco use. E-cigarettes may help some smokers quit, but they aren’t risk-free, and growing evidence suggests they may raise blood pressure. The goal is to quit nicotine entirely.
Quitting is arguably the single most effective thing you can do to prevent heart disease, and the benefit is even bigger once you add in cancer and lung disease.
The numbers are encouraging:
It is never too late. And you don't have to rely on willpower alone. Medications combined with counseling work far better, so ask your doctor for help.
Limiting Alcohol: Less Is Better
No alcohol is safest.
Alcohol is a known human carcinogen, and it doesn't matter whether it's wine, beer, or spirits.
It causes cancers of the mouth, throat, voice box, esophagus, liver, colon and rectum, and breast (in women). Even one drink a day or less can raise the risk of some cancers, including breast cancer.
The World Health Organization states that no safe level of drinking has been identified. Alcohol also raises blood pressure and triglycerides, increases the risk of atrial fibrillation, and damages the liver.
The upside is that cutting back lowers your risk over time.
If you drink, less is better.
Cancer Screening: Find It Early or Prevent It Entirely
Testing healthy people to find cancer early, when it's most treatable, or to prevent it altogether.
For example, removing precancerous polyps during a colonoscopy.
Usual recommendations for average-risk adults in the U.S.:
- Colorectal: Ages 45–75: colonoscopy every 10 years, or a stool-based test or other option. Ages 76–85: individual decision.
- Breast: Mammogram every 2 years, ages 40–74. Women at high risk (such as BRCA carriers) usually get a yearly mammogram plus a yearly breast MRI. Women with dense breasts should ask their clinician about extra imaging.
- Cervical: Ages 21–29: Pap test every 3 years. Ages 30–65: HPV test every 5 years. Most women can stop after 65 if prior results were normal.
- Lung: Yearly low-dose CT, ages 50–80, for people with a 20 pack-year smoking history who still smoke or quit within the past 15 years.
- Prostate: Men 55–69: talk with your clinician about the pros and cons of PSA testing. Men at higher risk, such as Black men or those with a family history, may start this conversation at 40–45.
Less smoking, earlier detection, and better treatment have cut U.S. cancer death rates by about a third since 1991.
The Bottom Line
If you don't test, you don't know.
Heart disease, diabetes, fatty liver, and most early cancers develop asymptomatically.
By the time there’s chest pain, a stroke, or a diagnosis, the problem has usually been building for years, sometimes decades.
Waiting for symptoms means waiting until the damage is already done.
The traditional approach is to wait for something to go wrong and then react. That’s backward.
A high ApoB or Lp(a), a creeping A1c, or a fasting insulin that’s quietly rising tells you where you’re headed long before you get there.
That’s the window when you have the most power to change course.
Caught early, many of these problems can be prevented, and others can be pushed back by years.
You can’t fix what you haven’t measured.
Ask for the tests, take your home blood pressure readings, and stay current on screening.
Then use what you learn to act before a problem starts.
Know Your Numbers Before The Problem
Most of the markers in this newsletter aren’t part of a standard annual physical.
A routine lipid panel won’t show your ApoB or Lp(a), and most routine labs check glucose but not fasting insulin. So many people don't know where they stand until there's a problem.
Function Health is an all-in-one health platform that starts with 160+ lab tests, including the blood markers covered in this issue:
- ApoB: the count of artery-clogging particles in your blood
- Lp(a): your inherited cholesterol risk, worth checking at least once
- Triglycerides and VLDL: the overlooked remnant risk
- Hemoglobin A1c, fasting glucose and fasting insulin: to catch insulin resistance years before diabetes
- Liver enzymes (ALT, AST and GGT): early signs of fatty liver
- hsCRP: hidden, low-grade inflammation
Beyond these, Function covers your hormones, kidneys, thyroid, immune system, cancer signals, toxins, and key nutrients. That’s about 5× as much testing as standard primary care labs, and bloodwork that would normally cost thousands of dollars out of pocket.
Scheduling is simple, with 2,000+ lab locations across the U.S., and most visits take around 15 minutes.
If you don’t test, you don’t know. If you want a baseline for the markers in this newsletter, see if Function is a good fit for you.
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Jeremy London, MD
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* Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user’s own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay seeking medical advice for any medical condition they may have and should consult their healthcare professionals for any such conditions.
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