Best High-Leverage Tests for Longevity

Tests where the result changes what you do

Cardiovascular

• ApoB annually after 30.
• Lp(a) once in a lifetime.
• CAC score once at 40–50; repeat if initially zero and in your 50s.
• Home blood-pressure cuff weekly to baseline, monthly for trend.

Metabolic

• HbA1c + fasting insulin annually.
• Liver enzymes + FIB-4 score — catches MASLD/NAFLD early.

Function and physical reserve

• VO₂max estimate (wearable or treadmill).
• Grip strength dynamometer.
• Gait speed (especially 60+).
• Chair-rise test (especially 50+).
• DEXA scan every 1–3 years.

Cancer and other screening

• Colonoscopy / FIT starting 45.
• Mammography starting 40–50 per guideline.
• Low-dose CT for lung-cancer-eligible adults.
• Cervical cytology + HPV testing per guideline.
• Skin checks — annual after 40.

Cognitive baseline (50+)

• MoCA as a serial-comparison reference.
• Hearing test annually after 50 — under-treated; significant dementia leverage.

Sleep

• Sleep apnea screen if risk factors.

Tests with lower ROI for most adults

Not useless, but lower-leverage:

• Single-timepoint epigenetic-age tests (noisy; trend-only).
• Whole-body MRI (high incidentaloma rate; specific use cases).
• Microbiome stool tests (interesting; rarely actionable).
• Genetic-disease panels (useful in specific situations; consequential decisions).
• "Hormone panels" without specific clinical question.

Tests to actively skip

• Heavy-metal tests without specific exposure history.
• "Adrenal fatigue" panels — the diagnosis isn’t clinically validated.
• Live blood analysis — not a real test.
• Comprehensive food-sensitivity panels via IgG — not validated for what they claim to measure.

Practical framework

Before any test, ask:

1. What will I do differently if it’s abnormal?
2. What will I do if it’s normal?
3. If the answer to both is "nothing different", skip the test.

Related entries

40s guide, ApoB, CAC score, VO2max, Function Health, InsideTracker.