Your annual physical tests the basics. But five markers that predict disease years before symptoms appear aren't included in standard panels. Here's what to ask for.
Your doctor orders "routine bloodwork" at your annual physical. You get a complete blood count, a basic metabolic panel, maybe a lipid panel. The results come back, everything is "within range," and you're told you're healthy.
Except the standard panel misses five markers that are among the most powerful predictors of future disease. They're not expensive. They're not exotic. They're just not included in the default order because the healthcare system is designed around treating disease, not preventing it.
1. Fasting Insulin
Your doctor tests fasting glucose. If it's below 100 mg/dL, they say your blood sugar is normal. But fasting glucose is the last domino to fall in the metabolic dysfunction cascade.
Fasting insulin tells you what your pancreas is doing to keep that glucose number normal. If your fasting glucose is 90 but your fasting insulin is 15 mIU/L, your pancreas is working very hard to maintain that "normal" glucose. This is insulin resistance — the precursor to prediabetes and type 2 diabetes — and it can be present for 5–10 years before glucose numbers become abnormal.
Optimal range
Optimal fasting insulin: 2–6 mIU/L. Concerning: above 10 mIU/L. If your fasting insulin is elevated, you have a window of opportunity to reverse the trajectory through lifestyle changes before it progresses to glucose dysregulation.
2. Apolipoprotein B (ApoB)
Standard lipid panels give you total cholesterol, LDL, HDL, and triglycerides. These are useful but incomplete. The particle that actually drives atherosclerosis (the buildup of plaque in arteries) is apolipoprotein B.
Every atherogenic lipoprotein particle — LDL, VLDL, IDL, Lp(a) — carries exactly one ApoB molecule. ApoB gives you a direct count of how many plaque-building particles are circulating in your blood. You can have "normal" LDL cholesterol but elevated ApoB, meaning you have a large number of small, dense LDL particles that are more atherogenic.
A 2019 JAMA Cardiology study found that ApoB was a stronger predictor of cardiovascular events than LDL cholesterol in every subgroup studied.
Optimal range
Optimal ApoB: below 80 mg/dL (some longevity physicians target below 60). This is one of the best tests for assessing actual cardiovascular risk, and most standard panels don't include it.
3. High-Sensitivity C-Reactive Protein (hs-CRP)
Standard CRP tests detect infection and acute inflammation. High-sensitivity CRP detects low-grade chronic inflammation — the kind that drives cardiovascular disease, cancer, neurodegenerative disease, and accelerated aging.
Chronic inflammation is often called "the silent killer" because it produces no symptoms until significant damage has occurred. Hs-CRP gives you a measurable signal.
Optimal range
Optimal hs-CRP: below 1.0 mg/L. Moderate risk: 1.0–3.0 mg/L. High risk: above 3.0 mg/L (rule out acute infection first). Elevated hs-CRP can be driven by visceral fat, poor sleep, chronic stress, processed food, excessive alcohol, or undiagnosed autoimmune conditions.
4. Lipoprotein(a) — Lp(a)
Lp(a) is a genetically determined lipoprotein particle that significantly increases cardiovascular risk. Unlike LDL cholesterol, which responds to diet and medication, Lp(a) is almost entirely determined by your genes. You either have elevated Lp(a) or you don't, and no amount of lifestyle change will meaningfully lower it.
Approximately 20% of the global population has elevated Lp(a). Most of them don't know it because it's not included in standard panels.
If you have elevated Lp(a), your cardiovascular risk management strategy needs to be more aggressive on every other modifiable factor. You need lower ApoB targets, more attention to blood pressure, and potentially earlier medical intervention. Knowing your Lp(a) status changes your entire risk calculation.
One-time test
Elevated: above 50 nmol/L (or above 30 mg/dL depending on the assay). You only need to test Lp(a) once in your life since it's genetically fixed. One test gives you information that changes your health strategy forever.
5. HOMA-IR (Calculated from Fasting Glucose + Fasting Insulin)
HOMA-IR isn't a blood test — it's a calculation: (fasting glucose × fasting insulin) / 405. It provides a standardized measure of insulin resistance that's more informative than either glucose or insulin alone.
- Optimal HOMA-IR: below 1.0
- Insulin sensitive: below 1.5
- Early insulin resistance: 1.5–2.5
- Significant insulin resistance: above 2.5
If you get both fasting glucose and fasting insulin tested (marker #1 above), you can calculate HOMA-IR yourself. It's the single best screening tool for metabolic dysfunction and it costs nothing beyond the two tests.
How to Get These Tested
Ask your doctor to add these to your next blood panel. Most labs can run all five for an additional $50–100 beyond the standard panel. Frame it as: "I'd like to add fasting insulin, ApoB, hs-CRP, and Lp(a) to my bloodwork."
If your doctor pushes back (some do, citing lack of symptoms), you can order them directly through services like Quest Diagnostics or Ulta Lab Tests without a physician order.
The bottom line
The investment is small. The information is potentially life-changing. And unlike most health interventions, you only need to test Lp(a) once.