Longevity Medicine

Establish Your Health Baseline

The power of early detection isn't just in catching disease—it's in establishing baselines that let you track your body over decades. This guide covers the latest evidence-based screening, from essential tests to cutting-edge imaging.

Updated January 2026 with latest clinical evidence.

The New Approach

From Reactive Screening to Proactive Baselines

Traditional medicine waits for symptoms, then screens. Longevity medicine takes a different approach: establish comprehensive baselines earlier than you think, then track changes over time.

The difference is profound. A single cardiac CT scan tells you if you have plaque. Serial scans over years tell you if your interventions are working—whether that plaque is stable, progressing, or actually regressing with aggressive treatment.

This is now possible thanks to advances in AI-powered imaging (like Cleerly for cardiac plaque), liquid biopsies for cancer, and a deeper understanding of which biomarkers actually predict outcomes.

Old Approach

• Wait for symptoms
• Get standard lipid panel
• CAC score once at 50
• React to abnormal findings

New Approach

• Establish baselines at 40
• ApoB + Lp(a) for true risk
• Quantitative plaque tracking
• Prove interventions are working

What We're Fighting

The Four Horsemen of Aging

Most people will die from one of four conditions. Each requires a distinct early detection strategy.

Heart Disease

The #1 killer. Often silent until a heart attack.

Detection Strategy

→ApoBApolipoprotein B — a protein on 'bad' cholesterol particles. Better predictor of heart disease risk than standard LDL cholesterol. & Lp(a)Lipoprotein(a) — a genetically inherited particle that raises heart attack and stroke risk. Levels don't change with diet or exercise. testing
→CAC scoreCoronary Artery Calcium score — a CT scan measuring calcium deposits in heart arteries. A score of zero indicates very low risk. as gatekeeper
→Cleerly CCTACleerly CT Coronary Angiography — FDA-cleared AI that quantifies all types of arterial plaque, including dangerous soft plaque that calcium scoring misses. for plaque quantification
→Serial imaging to track regression

Cancer

Many cancers are curable if caught early.

Detection Strategy

→Standard screenings (LDCTLow-Dose CT — a screening scan for lung cancer that uses much less radiation than a regular CT scan., colonoscopy, mammogram)
→Galleri MCEDGalleri Multi-Cancer Early Detection — a blood test that detects DNA signals from over 50 types of cancer before symptoms appear. as adjunct
→Full-body MRIA comprehensive MRI scan (e.g., Prenuvo) that images your entire body to create a reference baseline for future comparison. for baseline
→Genetic testingHereditary cancer panels, Lynch syndrome, BRCA1/2, and more — see the Genetic Testing section below. to reveal hidden risk

Neurodegenerative

Alzheimer's, Parkinson's. Limited screening available.

Detection Strategy

→Control vascular risk factorsConditions like high blood pressure, high cholesterol, and diabetes that damage blood vessels and increase dementia risk.
→Optimize sleep (treat apneaSleep apnea — a condition where breathing repeatedly stops during sleep. Linked to increased Alzheimer's risk and cardiovascular disease.)
→Metabolic health (insulin sensitivityHow efficiently your cells respond to insulin. Poor insulin sensitivity (insulin resistance) is linked to neurodegeneration and cognitive decline.)
→Cognitive baseline testing

Metabolic Disease

Type 2 diabetes, NAFLD. Highly preventable.

Detection Strategy

→Fasting insulinA blood test measuring insulin levels after an overnight fast. Catches insulin resistance years before glucose or HbA1c become abnormal. (not just glucose)
→HbA1cHemoglobin A1c — shows average blood sugar over 2-3 months. Normal is below 5.7%. and HOMA-IRHomeostatic Model Assessment for Insulin Resistance — a calculation using fasting glucose and insulin to quantify how resistant your cells are to insulin.
→CGMContinuous Glucose Monitor — a small sensor worn on the skin that tracks blood sugar levels in real-time, 24/7. trial for awareness
→DEXADual-Energy X-ray Absorptiometry — a scan that precisely measures bone density, lean muscle mass, and body fat distribution. for body composition

Cardiovascular Screenings

Heart & Vascular Health

Heart disease is the #1 killer—but also the most preventable with early detection.

Standard Lipid Panel

Who: Adults 20+
Tests: LDL, HDL, triglycerides, total cholesterol
Frequency: Every 4-6 years (more often if elevated)

Key question to ask:

"Given my numbers, what's my 10-year cardiovascular risk?"

Blood Pressure

Who: All adults
Tests: Blood pressure measurement
Frequency: At least every 2 years (annually if elevated)
Note: Target: Below 130/80 mmHg per ACC/AHA guidelines, with goal of approaching 120/80 where tolerated.

Key question to ask:

"Is my blood pressure well-controlled?"

Ask For This

Apolipoprotein B (ApoB)

Who: All adults 35+ (should be universal)
Tests: Blood test
Frequency: Annually with lipid panel
Note: 9 of 9 studies show ApoB outperforms LDL-C. ~20% of people with 'normal' LDL have elevated ApoB and hidden risk.

Key question to ask:

"Can you add ApoB to my lipid panel? It's a better predictor than LDL."

Ask For This

Lipoprotein(a) - Lp(a)

Who: All adults (one-time test)
Tests: Blood test
Frequency: Once in lifetime
Note: Elevated in 20-25% of population. 2-3x increased risk of MI and aortic stenosis. European/Canadian guidelines recommend universal testing.

Key question to ask:

"Have I ever had my Lp(a) tested? It's genetic and doesn't change."

Coronary Artery Calcium (CAC)

Who: Adults 40-45 (or earlier with risk factors)
Tests: Non-contrast CT scan (~$100-300)
Frequency: Once as gatekeeper, repeat in 5-7 years if zero
Note: Zero score = excellent prognosis. But CAC cannot see soft plaque—the dangerous kind that ruptures.

Key question to ask:

"Would a CAC score help determine if I need more aggressive treatment?"

New Science

Cleerly CCTA (AI Plaque Analysis)

Who: Adults with CAC > 0, family history, or risk factors
Tests: Contrast CT with AI quantification
Frequency: Baseline, then every 3-5 years to track
Note: FDA-cleared AI quantifies ALL plaque types. 2025 data shows non-obstructive high-plaque-burden patients have 22% MACE rate. Now covered by Aetna, UHC, Cigna.

Key question to ask:

"Can we do a Cleerly scan to quantify my plaque and track it over time?"

Why This Matters: Plaque Regression is Possible

With aggressive LDL lowering (target <70 mg/dL with statins, or even lower with PCSK9 inhibitors), studies show atherosclerotic plaque can actually regress. The GLAGOV trial showed 0.95% reduction in plaque volume with evolocumab. But you can only prove regression if you have a baseline and track over time. This is the power of serial Cleerly imaging.

Cancer Screenings

Standard evidence-based screenings plus emerging adjuncts for hard-to-detect cancers.

Standard Screenings (Strong Evidence)

Colorectal Cancer

Who: Adults 45-75 (earlier if family history)
Tests: Colonoscopy, FIT test, Cologuard
Frequency: Colonoscopy every 10 years, or FIT annually

Key question to ask:

"Given my family history, should I start earlier?"

Breast Cancer

Who: Women 40+ (earlier if high risk)
Tests: Mammogram, breast MRI for high-risk
Frequency: Annually or biannually depending on guidelines

Key question to ask:

"What's my breast density, and does that change my screening approach?"

Lung Cancer

Who: Adults 50-80 with 20+ pack-year history
Tests: Low-dose CT scan
Frequency: Annually
Note: One of the 'Big Three' most commonly misdiagnosed cancers

Key question to ask:

"Do I qualify for lung cancer screening based on my smoking history?"

Prostate Cancer

Who: Men 50+ (earlier if Black or family history)
Tests: PSA blood test, digital rectal exam
Frequency: Discuss with doctor based on risk

Key question to ask:

"What are the trade-offs of PSA screening for someone like me?"

Cervical Cancer

Who: Women 21-65
Tests: Pap smear, HPV test
Frequency: Every 3-5 years depending on age

Key question to ask:

"Should I get HPV co-testing?"

Skin Cancer

Who: Everyone, especially fair-skinned or high sun exposure
Tests: Full-body skin exam
Frequency: Annually, or more often if high risk

Key question to ask:

"Are there any spots you're monitoring or concerned about?"

Advanced Adjuncts (Emerging Evidence)

Advanced

Galleri Multi-Cancer Early Detection

Who: Adults 50+ (not a replacement for standard screening)
Tests: Blood test detecting cancer DNA signals
Frequency: Consider annually as adjunct
Note: NHS-Galleri trial (Feb 2026) failed primary endpoint but showed Stage IV reduction for deadliest cancers. PATHFINDER 2: 73.7% sensitivity, 99.6% specificity. FDA decision expected mid-2026.

Key question to ask:

"Is Galleri appropriate for me as an additional screening tool?"

Advanced

Full-Body MRI (Prenuvo)

Who: Adults 40+ seeking comprehensive baseline
Tests: Non-contrast whole-body MRI
Frequency: Baseline at 40, then every 2-3 years
Note: 16% false-positive rate. Not recommended by ACR for average-risk adults. Value is in baseline comparison over time—not single-point findings.

Key question to ask:

"Would a full-body MRI baseline help monitor for changes over time?"

Important Caveats on Advanced Screening

Galleri is not FDA-approved. The NHS-Galleri trial (Feb 2026) failed its primary endpoint of reducing Stage 3+4 cancers, though secondary analysis showed meaningful Stage IV reduction for the deadliest cancers. Best used as an adjunct for cancers without established screening (pancreatic, ovarian)—not a replacement for colonoscopy or mammogram.

Full-body MRI has real value in establishing a reference baseline—documenting benign findings now so future scans can detect change. But it has a 16% false-positive rate and the ACR does not recommend it for average-risk asymptomatic adults. Discuss with your physician.

High-Risk: Pancreatic Cancer Screening

For BRCA1/2 carriers and those with strong family history: Annual pancreatic screening with MRI/MRCP and endoscopic ultrasound starting at age 50 (or 10 years before the earliest family case). The CAPS5 study showed 73.3% 5-year survival in screening-detected pancreatic cancer vs. 1.5 years median survival when diagnosed outside surveillance.

Genetic Testing

Know Your Genetic Risk

Genetic tests reveal risks that no blood test or scan can detect — and many are one-time tests with lifelong implications.

Most hereditary risk goes undetected. An estimated 98% of Lynch syndrome carriersHampel et al. estimate that 1 in 279 people carry a Lynch syndrome mutation, yet the vast majority are never tested. are undiagnosed — missing the window for colonoscopy starting at 20-25 instead of 45. Similarly, 90% of people with familial hypercholesterolemiaNordestgaard et al., European Heart Journal 2013. Familial hypercholesterolemia affects ~1 in 250 people but is identified in fewer than 10% of cases. don't know they carry a mutation that can cause heart attacks in their 30s and 40s.

Beyond cancer and cardiovascular risk, roughly 90% of people carry at least one actionable pharmacogenomic variantPharmacogenomic variants affect how your body metabolizes medications — including common drugs like clopidogrel, SSRIs, codeine, and statins. that changes how they respond to common medications. A single genetic test, done once, can inform every prescription for the rest of your life.

Ask For This

Hereditary Cancer Panel

Who: Adults with family history of cancer before 50, or anyone seeking risk clarity
Tests: Multi-gene panel: BRCA1/2, PALB2, ATM, CHEK2, and others
Frequency: One-time
Note: NCCN 2025 expanded eligibility criteria. Carriers of BRCA1/2 mutations can achieve >90% risk reduction with prophylactic surgery and intensive surveillance.

Key question to ask:

"Do I meet NCCN criteria for hereditary cancer genetic testing?"

Ask For This

Lynch Syndrome Screening

Who: Adults with family history of colorectal, endometrial, or ovarian cancer
Tests: Genetic panel for MLH1, MSH2, MSH6, PMS2, EPCAM
Frequency: One-time
Note: 95% of carriers are undiagnosed. Lynch carriers should begin colonoscopy at 20-25 instead of 45. Daily aspirin chemoprevention reduces cancer risk in carriers (CAPP2 trial).

Key question to ask:

"Should I be tested for Lynch syndrome given my family history?"

Ask For This

Familial Hypercholesterolemia (FH)

Who: Adults with LDL >190, family history of early heart disease, or tendon xanthomas
Tests: Genetic panel for LDLR, APOB, PCSK9 mutations
Frequency: One-time
Note: Affects 1 in 250 people, 90% undiagnosed. FH carriers need aggressive lipid lowering early — see ApoB and Lp(a) cards in the cardiovascular section.

Key question to ask:

"Could my high cholesterol be genetic? Should I be tested for FH?"

Ask For This

Pharmacogenomics (PGx)

Who: All adults (ideally before starting new medications)
Tests: Multi-gene panel: CYP2D6, CYP2C19, CYP3A4, SLCO1B1, and others
Frequency: One-time (results apply for life)
Note: 90%+ of people carry at least one actionable variant. Affects response to statins, blood thinners, antidepressants, pain medications, and more. CPIC guidelines provide dosing recommendations for 100+ drug-gene pairs.

Key question to ask:

"Can I get pharmacogenomic testing so we know how I metabolize medications?"

Carrier Screening

Who: Adults planning pregnancy
Tests: Expanded carrier panel (100-300+ conditions)
Frequency: One-time, ideally before conception
Note: ACOG recommends offering carrier screening to all patients planning pregnancy. Tests for conditions like cystic fibrosis, sickle cell disease, spinal muscular atrophy, and fragile X.

Key question to ask:

"Should my partner and I get carrier screening before starting a family?"

Advanced

Whole Genome Sequencing

Who: Adults seeking the most comprehensive genetic picture
Tests: Complete DNA sequencing (~20,000 genes)
Frequency: One-time
Note: Most comprehensive but generates variants of uncertain significance (VUS) that can cause anxiety. Not standard for screening. Requires genetic counseling to interpret results appropriately.

Key question to ask:

"Would whole genome sequencing provide useful information beyond targeted panels?"

Metabolic Health

Metabolic & Body Composition

Type 2 diabetes and metabolic dysfunction are largely preventable with early detection.

Ask For This

DEXA Scan

Who: Adults 40+ for baseline (not just 65+ women)
Tests: Dual-energy X-ray absorptiometry
Frequency: Baseline at 40, then every 2-3 years
Note: Measures bone density, lean mass, visceral fat. Sarcopenia (age-related muscle loss) begins in your 40s and is a leading predictor of frailty and falls. Establishing a baseline early lets you track and intervene before it's clinical.

Key question to ask:

"Can I get a DEXA scan for body composition, not just bone density?"

Ask For This

Fasting Insulin & HOMA-IR

Who: All adults 35+
Tests: Blood test (fasting)
Frequency: Annually with metabolic panel
Note: Fasting glucose/HbA1c catches diabetes late. Fasting insulin catches insulin resistance years earlier.

Key question to ask:

"Can you add fasting insulin to my labs? I want to know my insulin sensitivity."

HbA1c / Fasting Glucose

Who: Adults 35+ (earlier if overweight or family history)
Tests: Blood test
Frequency: Every 3 years if normal

Key question to ask:

"Should I be screened for prediabetes given my risk factors?"

Advanced

CGM Trial

Who: Anyone seeking metabolic awareness
Tests: Continuous glucose monitor (2 weeks)
Frequency: One trial for education, not ongoing
Note: Evidence for non-diabetics is limited, but real-time biofeedback changes behavior. Time above 140 mg/dL varies by study (2-12% in healthy adults).

Key question to ask:

"Could I try a CGM for a couple weeks to see how I respond to foods?"

Liver Health (NAFLD)

Who: Adults with metabolic risk factors
Tests: ALT, AST, GGT; FibroScan if elevated
Frequency: Annually with metabolic panel
Note: NAFLD affects 25% of adults and is often silent.

Key question to ask:

"Given my weight/metabolic markers, should I be screened for fatty liver?"

Thyroid Function

Who: All adults, especially women
Tests: TSH, free T4
Frequency: Every 5 years, or more often if symptoms

Key question to ask:

"Have I had my thyroid checked recently?"

Other Screenings

Other Important Screenings

Hepatitis C

Who: All adults 18-79 (one-time screening)
Tests: Blood test
Frequency: One-time

Key question to ask:

"Have I been screened for Hepatitis C?"

HIV

Who: All adults 13-64 (one-time, or more often based on risk)
Tests: Blood test
Frequency: One-time or based on risk

Key question to ask:

"Should I be retested based on my risk factors?"

Bone Density (DEXA)

Who: Women 65+, men 70+ (earlier if risk factors)
Tests: DEXA scan
Frequency: Every 2 years if at risk
Note: Consider baseline at 40 for body composition—see Metabolic section

Key question to ask:

"Should I get a bone density scan given my risk factors?"

Eye Exam

Who: Adults 40+ (earlier if diabetic)
Tests: Comprehensive eye exam
Frequency: Every 1-2 years

Key question to ask:

"Should I be screened for glaucoma or macular degeneration?"

When to Start

Your Baseline Timeline

Now that you know the tests, here's when to establish key baselines by age.

Age 35-40

Establish Core Baselines

ApoB (better than LDL for CV risk prediction)
Lp(a) (one-time, genetically determined)
Fasting insulin + HbA1c + HOMA-IR
Comprehensive metabolic panel
Pharmacogenomic (PGx) testing — one-time, informs all future prescriptions
Discuss hereditary cancer panel if family history of cancer before 50
Consider: DEXA for body composition baseline

Age 40-45

Add Imaging Baselines

CAC score (coronary artery calcium)
If CAC > 0 or risk factors: Consider Cleerly CCTA
Hereditary cancer panel if not done — NCCN 2025 broadened eligibility
Consider: Full-body MRI (Prenuvo) as reference baseline
DEXA scan if not done earlier
Colonoscopy at 45 (or earlier if family history)

Age 45-50

Full Cancer Screening Cadence

Colonoscopy (if not done at 45)
Mammogram (women, annual or biannual)
PSA discussion (men)
LDCT if smoking history (50-80)
Consider: Galleri MCED as adjunct for gaps

Age 50+

Higher-Intensity Monitoring

Repeat Cleerly CCTA every 3-5 years if baseline abnormal
Annual cancer screenings
DEXA every 2 years
Full-body MRI every 2-3 years if using
Pancreatic screening if BRCA1/2 carrier
Reassess genetic results as new gene-disease associations are discovered

Sources & Further Reading

Cardiovascular: CONFIRM2 Registry (2025), Nature Reviews Cardiology AI-QCT Consensus Statement (2025), ESC/EAS Lipid Guidelines, National Lipid Association Lp(a) Statement (2024), GLAGOV Trial

Cancer: GRAIL PATHFINDER 2 Study (2025), NHS-Galleri Trial (Feb 2026), JMRI Whole-Body MRI Meta-Analysis (2019), CAPS5 Pancreatic Screening Study

Metabolic: Nature GluFormer CGM Study (2025), JCEM CGM Reference Ranges (2025), JAMA Sarcopenia Meta-Analysis

Genetics: NCCN Genetic/Familial High-Risk Assessment (2025), Hampel et al. Lynch Syndrome Prevalence, Nordestgaard et al. FH Consensus (European Heart Journal 2013), CPIC Pharmacogenomics Guidelines, GINA (2008)

Diagnostic Errors: Newman-Toker et al., BMJ Quality & Safety

Disclaimer: This information is for educational purposes only and does not constitute medical advice. Screening recommendations vary based on individual risk factors, family history, and regional guidelines. Some tests mentioned (Galleri, Cleerly, full-body MRI) are not universally covered by insurance and may not be recommended by all medical societies. Always consult with your healthcare provider to determine the appropriate screening schedule for your situation.