10 markers
Heart & Circulation
Lipids, apolipoproteins and other cardiovascular markers — the measures population research most closely associates with long-term heart health.
ApoB and Lp(a) almost never included in NHS testsA count of atherogenic (cholesterol-carrying) particles — one ApoB per particle. Research associates it with cardiovascular outcomes more closely than LDL cholesterol alone.
Each ApoB particle can lodge in artery walls. Low ApoB is the single strongest modifiable lipid target for cardiovascular longevity.
The main protein component of HDL — reflects how effectively your body clears cholesterol from artery walls.
The ApoB:ApoA1 ratio is one of the strongest longevity lipid markers, combining both sides of the atherogenic equation.
A genetically determined lipoprotein that dramatically elevates cardiovascular risk — and is invisible to standard cholesterol tests.
Up to 20% of the population carry elevated Lp(a) without knowing it. It's largely hereditary and unaffected by lifestyle — but knowing changes clinical management entirely.
Low-density lipoprotein — the main carrier of cholesterol through the bloodstream. High levels drive plaque formation.
LDL is a useful but imprecise metric — ApoB is the more accurate target. Knowing both tells you whether your LDL risk is being fully captured.
High-density lipoprotein — removes cholesterol from artery walls and transports it back to the liver.
Higher HDL is associated with lower cardiovascular risk at population level, though in some large cohorts very high HDL (>2.5 mmol/L) is associated with higher mortality. The ratio to total cholesterol matters as much as the absolute number.
The total amount of cholesterol in your blood — the starting point for cardiovascular risk assessment.
On its own, total cholesterol says little about cardiovascular risk. Its value is in enabling ratios (TC:HDL, non-HDL) that give a more complete picture.
All the potentially harmful cholesterol in your blood — total cholesterol minus HDL. A more complete cardiovascular risk marker than LDL alone.
Non-HDL captures VLDL, IDL and other atherogenic particles that LDL misses; research associates it more closely than LDL with long-term cardiovascular events.
The ratio of total cholesterol to HDL — an input to standard cardiovascular risk scores.
Total and HDL cholesterol combined in a single number. Research associates it with cardiovascular outcomes more closely than either value alone.
Fat molecules in the bloodstream — elevated levels signal poor metabolic health, excess carbohydrate intake, or liver stress.
High triglycerides alongside low HDL is a pattern the literature links to how the body handles carbohydrates and fat. Fasting triglycerides are among the earliest metabolic markers to shift.
The ratio of triglycerides to HDL — a compact read on how the body is handling fats and sugars together.
A TG:HDL ratio above 2.0 tracks closely with how effectively insulin moves glucose and fat into cells — it often shifts years before fasting glucose does.
3 markers
Metabolic & Blood Sugar
Glucose control, insulin sensitivity, and metabolic flexibility — where pre-diabetes hides for years before it's clinically flagged.
NHS blood sugar threshold misses years of early warning signsA three-month average of blood sugar levels — the most reliable single measure of glucose control.
Chronic elevated glucose accelerates vascular ageing, cognitive decline, and cellular damage. HbA1c is the best single snapshot of this risk.
Blood sugar measured after an overnight fast — one of the standard measures of glucose regulation.
Even fasting glucose in the high-normal range (5.0–5.6) is associated with higher cardiovascular risk in population studies, and with insulin working harder to hold glucose in range.
A metabolic waste product cleared by the kidneys — higher levels are associated with urate crystals forming in the joints, and track with sugar (especially fructose) metabolism and kidney load.
Research associates higher uric acid with cardiovascular disease and metabolic syndrome at population level, independently of other factors. In studies it often rises before other metabolic markers change.
12 markers
Liver & Kidney
Liver enzymes and kidney filtration markers. Small shifts within the standard range are worth knowing about, and worth rechecking over time.
Kidney function only flagged when it's seriously reduced — not earlierThe primary liver enzyme — elevated when liver cells are under stress from fat accumulation, alcohol, or inflammation.
Fat building up in the liver is common, usually silent, and closely tied to how the body handles sugar and fat. ALT is the earliest accessible signal — normal-range ALT above 20 still warrants attention in context.
A liver and muscle enzyme — elevated in liver disease, intense exercise, or muscle damage. The AST:ALT ratio helps distinguish causes.
The AST:ALT ratio shows where liver stress is coming from: above 2:1 is the pattern the literature associates with alcohol; below 1:1 with fat building up in the liver or, less often, a viral infection. The ratio is as informative as the absolute values.
A sensitive liver enzyme that rises before ALT — particularly responsive to alcohol intake, fatty liver, and oxidative stress.
GGT elevation within the 'normal' range is independently associated with cardiovascular mortality. It's one of the earliest and most sensitive markers of metabolic liver stress.
An enzyme present in the liver, bone, and bile ducts — elevated in bile duct obstruction, bone disorders, or liver disease.
ALP provides context for interpreting other liver enzymes and can flag bone metabolism issues that other markers miss.
The most abundant protein in blood. It is made by the liver, keeps fluid inside blood vessels, and carries hormones, calcium and some medicines.
Albumin is one of the inputs to research measures of biological age. It can fall with inflammation, illness and low protein intake, so it is best read alongside CRP and the other liver markers.
The total amount of protein in blood: albumin plus the globulins. Part of a standard liver function test.
Total protein is rarely informative on its own. It gives context to albumin and globulin, and hydration on the day can shift it.
The group of blood proteins other than albumin, including antibodies and carrier proteins. Most labs calculate it as total protein minus albumin.
Globulin tends to rise with ongoing inflammation or immune activity. It is read alongside albumin and CRP rather than on its own.
Total bilirubin: the pigment left when red blood cells are broken down, processed by the liver and cleared in bile. Not the same test as direct (conjugated) bilirubin.
Bilirubin gives context to the liver enzymes. A mildly raised result with otherwise normal liver tests is common and can rise with fasting or illness; a GP can say whether it needs looking into.
An enzyme found mainly in muscle. Strenuous or unaccustomed exercise in the days before a test can raise it well above the lab's range.
CK helps read ALT and AST, which muscle also releases: raised enzymes with a raised CK after training point to muscle rather than the liver. Recent exercise is worth noting when the test is taken.
An estimate, calculated from creatinine, of how well the kidneys filter waste from the blood — the standard measure of kidney filtration.
Kidney function declines silently with age and metabolic disease. eGFR below 90 — still 'normal' by NHS standards — is associated with elevated cardiovascular and all-cause mortality risk.
A muscle metabolism waste product filtered by the kidneys — the raw value behind the eGFR calculation.
Creatinine trends over time are more informative than any single reading. A rising creatinine within the 'normal' range can precede kidney function decline by years.
A nitrogen waste product from protein metabolism — filtered by the kidneys. High levels suggest kidney stress or very high protein intake.
Urea:creatinine ratio helps distinguish kidney disease from dehydration or high dietary protein — essential context for interpreting either marker alone.
17 markers
Hormones & Thyroid
Sex hormones, thyroid function, vitamin D — where energy, mood, body composition and recovery are decided.
Free T3, DHEA-S and free testosterone rarely tested on NHSThe primary androgen hormone — responsible for muscle mass, bone density, libido, mood, and metabolic rate in both men and women.
Testosterone declines ~1–2% per year from the mid-30s. In men, low testosterone is associated with less efficient glucose handling, loss of muscle mass, and higher cardiovascular risk — often years before symptoms become obvious.
The biologically active fraction of testosterone — what's actually available for your tissues to use.
Total testosterone can look normal while SHBG is high, leaving very little free — the form that matters. Free testosterone gives the true picture of androgenic status.
A protein that binds testosterone and oestrogen, regulating how much is biologically active.
High SHBG makes total testosterone look normal while reducing what's available to tissue. Low SHBG often travels with higher insulin levels, since insulin suppresses SHBG production in the liver. Neither extreme is optimal.
The main oestrogen — involved in bone density, cardiovascular function, brain function and mood in both sexes.
In men, oestradiol from testosterone aromatisation is often overlooked. Both high and low extremes increase cardiovascular risk and affect cognition and bone density.
An adrenal androgen precursor that declines markedly with age — one of the most reliably age-sensitive hormones measured.
DHEA-S is associated with immune function, insulin sensitivity, and lean mass preservation. In multiple cohort studies, lower levels are associated with higher all-cause mortality.
The primary stress hormone — regulates inflammation, blood sugar, immune function, and the sleep-wake cycle.
Chronically elevated cortisol raises blood sugar and makes insulin work harder, dampens immune activity, and is linked to shrinkage of the hippocampus, a memory centre. A single morning reading provides limited insight but flags the extremes.
A pituitary hormone — significantly elevated levels in men can suppress testosterone production and signal pituitary pathology.
Elevated prolactin is one of the most commonly missed causes of low testosterone in men under 40. It's reversible if caught — and easily missed without testing.
A pituitary hormone that drives sperm and egg production — a key marker of reproductive and hormonal axis health.
In men, higher FSH is associated with reduced testicular reserve. In women, FSH typically rises through the transition to menopause, often before cycle changes.
A pituitary hormone that triggers testosterone production in men and ovulation in women.
LH:FSH ratio and absolute levels help locate where in the hormonal axis dysfunction is occurring — pituitary versus gonadal. Critical for accurate testosterone interpretation.
The pituitary signal that drives thyroid hormone production — the most commonly measured thyroid marker.
TSH in the upper half of 'normal' (2.0–4.0) is associated with higher cholesterol, fatigue, and weight gain. Optimal TSH is typically below 2.0.
The main thyroid hormone circulating in the blood — a more direct measure of thyroid output than TSH alone.
TSH alone misses cases where the pituitary is compensating for declining thyroid output still within range. Free T4 shows whether the gland is actually delivering.
The metabolically active thyroid hormone — converted from T4 in tissues. The most direct measure of thyroid activity at the cellular level.
T4 is converted to the active hormone T3 in the tissues, and conversion varies between people. Free T3 measures that active hormone directly and is often left off standard thyroid panels.
Antibodies against thyroid peroxidase, an enzyme the thyroid uses to make its hormones.
Raised TPO antibodies are associated with autoimmune thyroid conditions and can appear years before TSH or free T4 change. A raised result is worth discussing with a GP alongside TSH and free T4.
Antibodies against thyroglobulin, the protein the thyroid uses to store and make its hormones. Not the same test as thyroglobulin itself.
Raised thyroglobulin antibodies are associated with autoimmune thyroid conditions and can appear before TSH or free T4 change. A raised result is worth discussing with a GP alongside TSH and free T4.
Total thyroxine: free T4 plus the T4 bound to carrier proteins. Not the same test as free T4.
Total T4 moves with the level of carrier proteins, which oestrogen, pregnancy and some medicines raise. Free T4 is usually the more direct measure, so total T4 is read alongside it.
Reverse T3: a form of T3 the body makes from T4 that does not act as thyroid hormone.
Reverse T3 can rise during illness, calorie restriction or stress. There is no agreed use for it in standard thyroid care, so Vigil reads it against the lab's range and alongside TSH, free T4 and free T3.
A steroid hormone precursor that regulates immune function, bone mineralisation, muscle strength, and testosterone synthesis.
Deficiency is endemic in the UK. The NHS sufficiency threshold (50 nmol/L) falls well below the levels associated with optimal immune function and cancer risk reduction (100+ nmol/L).
27 markers
Blood & Inflammation
Full blood count, inflammatory markers, and key micronutrients. The systemic background against which everything else plays out.
The more sensitive version of CRP almost never ordered routinelyA sensitive marker of low-grade systemic inflammation — the type that silently damages blood vessels over decades.
Research associates chronic low-grade inflammation (hs-CRP 1–3 mg/L) with cardiovascular events at population level, independently of cholesterol. Values in this band sit within standard lab ranges but above the longevity-optimal band. A result of 10 mg/L or more usually reflects a recent infection, injury or other short-term cause rather than low-grade inflammation, so it is not read that way.
An amino acid made in normal metabolism that damages blood vessel walls when elevated — B12, B6 and folate are needed to clear it, and some genetic variants slow that clearance.
Elevated homocysteine is independently associated with cardiovascular disease, cognitive decline, and dementia. Often correctable with B12, B6, and folate.
A non-specific marker of inflammation — measures how quickly red blood cells settle, which rises with inflammatory proteins in the blood.
ESR provides a different window on inflammation than hs-CRP and is particularly useful when tracking chronic inflammatory conditions over time.
The oxygen-carrying protein in red blood cells — the primary measure of anaemia.
Both low and high haemoglobin impair oxygen delivery and longevity. High-normal haemoglobin in the absence of dehydration or EPO use suggests good physiological reserve.
The proportion of blood volume occupied by red blood cells — a measure of blood density and oxygen-carrying capacity.
Haematocrit tracks closely with haemoglobin and adds context for hydration status. Chronically high haematocrit increases clotting risk.
The average size of red blood cells — smaller cells often reflect low iron; larger cells often reflect low B12 or folate.
MCV is key to reading the rest of the red-cell panel. Red cells growing larger while haemoglobin is still normal can be an early sign that B12 or folate is running low — before haemoglobin itself falls.
The average amount of haemoglobin per red blood cell — a measure of how well each cell is loaded with oxygen-carrying capacity.
MCH mirrors MCV in most anaemias and provides an additional angle on red cell quality — particularly useful when tracking B12 repletion.
The total count of red blood cells — provides context for haemoglobin and haematocrit readings.
RBC in combination with MCV and MCH distinguishes the type of anaemia — iron deficient, B vitamin deficient, or due to chronic disease — each with different implications for longevity.
The count of immune cells in the blood — elevated in infection, inflammation, or immune activation; low in immune suppression.
Chronically elevated WBC within the 'normal' range (8–11) is independently associated with cardiovascular events and all-cause mortality. Optimal immune function sits in the lower half of the reference range.
The most abundant white blood cell — the first responder to infection and tissue damage.
The neutrophil:lymphocyte ratio (NLR) is an emerging longevity marker. A high NLR reflects immune ageing and chronic inflammatory stress, and in cohort studies is associated with mortality independently of other markers.
The immune cells responsible for targeted defence — T cells, B cells, and NK cells. Declining lymphocyte counts are a hallmark of immune ageing.
Lymphocyte count and the neutrophil:lymphocyte ratio together track more closely with research measures of biological age than most single inflammatory markers.
Cell fragments essential for blood clotting — extremes in either direction carry risk.
High platelets are associated with chronic inflammation and elevated clotting risk. The platelet:lymphocyte ratio is another emerging inflammatory marker used in cancer risk stratification.
The average concentration of haemoglobin in red blood cells, calculated from haemoglobin and haematocrit.
MCHC is read with MCV and MCH to describe red cells. A delay before the sample is tested can lower it slightly.
Red cell distribution width: how much red blood cells vary in size. Reported on every full blood count.
Higher RDW is associated with higher all-cause mortality in population studies, even within the normal range, and it is one of the inputs to research measures of biological age. It can rise when iron, B12 or folate run low, so it is read alongside them.
The average size of platelets. Read alongside the platelet count.
MPV adds context to the platelet count. It shifts with how long the sample waits before testing, so small changes between tests are rarely meaningful.
A type of white blood cell that clears damaged cells and debris and helps coordinate the immune response.
Monocytes are read as part of the white cell count, alongside neutrophils and lymphocytes. A recent infection can raise them for a few weeks.
A type of white blood cell involved in allergic responses and defence against parasites.
Eosinophils are read as part of the white cell count. Hay fever, asthma and eczema commonly raise them a little.
The least common type of white blood cell, involved in allergic and inflammatory responses.
Basophils are read as part of the white cell count. They are normally very low, so small changes are rarely meaningful.
The body's iron storage protein — low ferritin depletes energy and immune function; high ferritin can mean stored iron is building up, or can rise with inflammation.
Many women are iron-depleted despite 'normal' ferritin (13–30 µg/L). Conversely, elevated ferritin in men often reflects liver stress or inherited iron loading rather than dietary iron excess.
The amount of iron circulating in the blood — fluctuates significantly with meals and time of day, so best interpreted alongside ferritin.
Serum iron alone is highly variable, but combined with ferritin and transferrin saturation it reveals whether iron stores are depleted, overloaded, or poorly utilised.
The percentage of iron-transport capacity (transferrin) that is currently loaded with iron — a core part of iron studies, read alongside ferritin.
A raised transferrin saturation alongside raised ferritin is the pattern clinicians use to decide whether to investigate iron overload further.
Total iron binding capacity: how much iron transferrin, the blood's iron-transport protein, could carry if fully loaded.
TIBC tends to rise when iron stores run low and fall with inflammation. It is read with ferritin, serum iron and transferrin saturation, never alone.
Unsaturated iron binding capacity: the part of transferrin not yet carrying iron. Added to serum iron, it gives TIBC.
UIBC is part of iron studies and is read with ferritin, serum iron and transferrin saturation, never alone.
Vitamin B9 — essential for DNA synthesis, red blood cell production, and homocysteine metabolism.
Folate is the primary driver of homocysteine conversion. Low folate elevates homocysteine, which in turn damages blood vessels and is linked to cognitive decline.
Essential for nerve function, DNA synthesis and red blood cell production. Prolonged deficiency can lead to lasting nerve damage.
The NHS lower limit (145 pmol/L) is a threshold for deficiency, not an optimal level. Neurological symptoms have been reported at levels well above it. The optimal band is considerably higher.
A cofactor in over 300 enzymatic reactions — regulates muscle and nerve function, blood pressure, blood sugar, and protein synthesis.
Low magnesium is associated with less efficient insulin signalling, higher blood pressure, and cardiovascular disease in population studies. Serum magnesium is an imperfect proxy (most is intracellular), so the lower end of 'normal' is likely still suboptimal.
An essential mineral for immune function, testosterone synthesis, wound healing, and DNA repair.
Zinc is needed for testosterone synthesis and immune function. It is rarely included in standard panels. Plant-heavy diets can reduce zinc absorption, because phytates in grains and legumes bind it.