Longevity biomarkers are objective measurements that predict your healthy lifespan better than chronological age. These are the 10 you should know about.
Longevity biomarkers are objective measurements — from blood, physical performance or epigenetics — that predict your healthy lifespan more accurately than your date of birth. They are the difference between knowing how old you are and knowing how your body is actually aging.
The idea is straightforward: two 50-year-olds can have bodies that function in radically different ways. One may have the aerobic capacity of a 35-year-old while the other has inflammation markers typical of someone aged 65. Your ID card says nothing useful about this. Biomarkers do.
Peter Attia sums it up well in Outlive: conventional medicine waits for disease to appear before acting. Longevity medicine — what he calls "Medicine 3.0" — uses biomarkers to detect deterioration years before it becomes a diagnosis. Measure first, intervene second, measure again.
At Progevita we measure over 50 biomarkers in every programme. But not all carry equal weight. Some predict mortality with a statistical power that makes measuring many others unnecessary. Here are the 10 that scientific evidence points to as the most relevant.
1. VO₂max — your cardiorespiratory fitness
VO₂max measures the maximum amount of oxygen your body can use during intense exercise, in millilitres per kilogram of body weight per minute (mL/kg/min). It is arguably the single best predictor of all-cause mortality we have.
The most compelling data comes from a 2018 study published in JAMA Network Open (Mandsager et al., PMID: 30382293) with 122,007 patients followed for over a decade: those with the highest aerobic capacity had a 5-fold lower mortality risk compared to those with low fitness. Each additional MET of cardiorespiratory fitness was associated with 13% lower mortality. No drug has demonstrated a comparable risk reduction.
Interestingly, there was no plateau: more aerobic fitness was always better, even at the highest levels. No point of "too much fitness" was found.
| Classification | VO₂max men (mL/kg/min) | VO₂max women (mL/kg/min) | Relative mortality risk |
|---|---|---|---|
| Low | < 30 | < 25 | Reference (1.0) |
| Below average | 30–35 | 25–30 | 0.71 |
| Average | 35–40 | 30–35 | 0.55 |
| Above average | 40–45 | 35–40 | 0.39 |
| High / Elite | ≥ 45 | ≥ 38 | 0.20 |
How it's measured: exercise test with gas analyser (cardiopulmonary exercise testing). At Progevita we use the Q-NRG max during a graded test on a treadmill or bike. It takes about 15 minutes and requires wearing a mask that measures gas exchange in real time.
Longevity target: men ≥ 40 mL/kg/min, women ≥ 35 mL/kg/min. Ideally, be in the 75th percentile or above for your age group.
2. Grip strength — more than squeezing hard
It might seem like an overly simple test. You squeeze a dynamometer as hard as you can and get a number in kilograms. But that figure predicts mortality, disability, cognitive decline and hospitalisation with a consistency that has surprised researchers for decades.
The PURE study (Leong et al., The Lancet, 2015, PMID: 25982160) analysed 139,691 people across 17 countries over four years. Result: each 5 kg reduction in grip strength was associated with 16% higher all-cause mortality and 17% higher cardiovascular mortality. Grip strength was a better predictor of cardiovascular death than systolic blood pressure itself.
Why does something so simple work so well? Because grip strength doesn't just measure your hand. It's a proxy for your total muscle mass, neuromuscular function and overall health status. It's like taking the temperature of your entire musculoskeletal system with a single number.
How it's measured: handheld dynamometer. Three attempts with each hand, best value recorded. Measured in every Progevita programme as part of the Longevity evaluation.
Guideline targets: men ≥ 40 kg, women ≥ 25 kg. What matters most is being above the 50th percentile for your age and sex group, ideally the 75th+.
3. HbA1c and fasting glucose — metabolic control
Glycated haemoglobin (HbA1c) reflects your average blood glucose over the past 2-3 months. It is the most reliable mid-term marker of metabolic control, and elevated levels — even within the "normal" range — are associated with higher cardiovascular risk, cognitive decline, cancer and mortality.
Conventional medicine diagnoses diabetes at HbA1c ≥ 6.5% and prediabetes at 5.7%. But studies in centenarians show that the longest-lived people maintain levels below 5.5% throughout their lives. Each percentage point increase above 5.0% is associated with 20-30% higher cardiovascular mortality risk.
Fasting glucose complements HbA1c: it tells you how your metabolism is doing this morning, not over the past three months. Values between 70-90 mg/dL are optimal for longevity; above 100 mg/dL already indicates insulin resistance, even if it's not "diabetic."
Fasting insulin is the earliest sentinel: it rises years before glucose does. Levels above 8 µU/mL already suggest the body is producing more insulin than it should to control blood sugar. The ideal: below 5 µU/mL.
| Marker | Conventional "normal" range | Optimal range for longevity | Recommended frequency |
|---|---|---|---|
| HbA1c | < 5.7% | 4.8 – 5.4% | Every 6 months |
| Fasting glucose | 70 – 100 mg/dL | 70 – 90 mg/dL | Annual |
| Fasting insulin | 2 – 25 µU/mL | 2 – 5 µU/mL | Annual |
| HOMA-IR | < 2.5 | < 1.5 | Annual |
How to improve: reduce refined carbohydrates, add fasting windows (12-16 hours), resistance train (muscle is a glucose "sink"), sleep 7-8 hours and manage stress. At Progevita, the Inflammaging programme includes metabolic diagnostics and a personalised anti-inflammatory nutrition plan.
4. hsCRP and suPAR — silent chronic inflammation
Low-grade chronic inflammation — what science calls inflammaging — is probably the greatest accelerator of aging. It doesn't hurt, doesn't cause fever, produces no obvious symptoms. But it damages blood vessels, neurons, joints and tissues for years before a diagnosable disease appears.
High-sensitivity C-reactive protein (hsCRP) is the classic marker. The CANTOS study (Ridker et al., NEJM, 2017, PMID: 28845751) demonstrated that reducing inflammation with an anti-IL-1β antibody lowered cardiovascular events by 15%, independent of cholesterol levels. Optimal hsCRP levels for longevity are below 1.0 mg/L. Above 3.0 mg/L, cardiovascular risk triples.
suPAR (soluble urokinase plasminogen activator receptor) is newer and, in some respects, more informative. While hsCRP fluctuates with acute infections, suPAR reflects stable, chronic systemic inflammation (Rasmussen et al., J Gerontol A, 2021, PMID: 32710613). It correlates with accelerated ageing, cardiovascular disease, cancer, diabetes and cognitive decline.
How it's measured: both from a standard blood draw. At Progevita, the suPAR test is included in the Inflammaging and Women's Vital Path programmes, with immediate results.
Longevity target: hsCRP < 1.0 mg/L, suPAR in the low range for your age.
5. ApoB — the number that matters in your lipid profile
Forget "good cholesterol and bad cholesterol" as absolute categories. In longevity medicine, the marker that has proven most accurate for predicting cardiovascular risk is apolipoprotein B (ApoB).
ApoB counts the actual number of atherogenic particles circulating in your blood — every LDL, VLDL and IDL particle carries exactly one ApoB molecule. Conventional LDL cholesterol measures the cholesterol content inside those particles, but two people with the same LDL can have very different particle counts. And what damages arteries is the particles, not the cholesterol they carry.
A systematic analysis published in the Journal of Clinical Lipidology (Sniderman et al., 2025) confirmed that in 9 out of 9 discordance studies, ApoB was superior to LDL-C as a predictor of cardiovascular risk. The European Society of Cardiology (2019) already recommends ApoB as the primary marker.
Longevity target: ApoB < 90 mg/dL for primary prevention, < 65 mg/dL with existing risk factors. Peter Attia and other longevity leaders recommend even < 60 mg/dL as an aggressive long-term goal.
How it's measured: blood test. Strict fasting is not required (ApoB is stable). At Progevita we include it in the cardiovascular risk profile available as a complementary diagnostic.
6. Vitamin D — far beyond bones
Vitamin D stopped being just "the bone vitamin" over a decade ago. It is a hormone that regulates the expression of more than 1,000 genes, influences immune function, inflammation, insulin sensitivity and cognitive function.
The problem: an estimated 40-60% of the adult population in Europe has insufficient levels (< 30 ng/mL), even in Mediterranean countries. Optimal levels for longevity are between 40 and 60 ng/mL — well above the 20 ng/mL minimum that many labs mark as "sufficient."
Low vitamin D levels are associated with higher all-cause mortality, higher infection rates, greater risk of osteoporosis and fractures, poorer immune response and higher prevalence of depression. Correcting a vitamin D deficit is one of the simplest, cheapest and highest-impact interventions available.
Longevity target: 40 – 60 ng/mL (100 – 150 nmol/L). Test at least every 6 months, especially if you live at high latitudes or have limited sun exposure.
Typical supplementation: 1,000 – 4,000 IU/day of vitamin D3, together with vitamin K2 (to direct calcium towards bones rather than arteries). Adjust based on blood work.
7. Homocysteine — the silent methylation marker
Homocysteine is an amino acid that accumulates when the body's methylation cycles are not working properly. Elevated levels are associated with higher cardiovascular risk, cognitive decline, dementia and osteoporotic fractures.
The "normal" lab range extends up to 15 µmol/L, but evidence suggests that levels above 10 µmol/L are already associated with increased risk. The goal in longevity medicine: keep it below 8 µmol/L.
Elevated homocysteine usually indicates deficiencies in vitamins B6, B9 (folate) and B12 — cofactors needed for methylation. Correcting these deficits with oral supplementation typically normalises levels within weeks. It's a marker that's easy to measure and easy to fix, but that few doctors routinely request.
Longevity target: < 8 µmol/L. Test every 6-12 months.
8. Hormones — testosterone, oestradiol and thyroid
Hormones are not just "sex hormones." They regulate body composition, mood, cognition, sleep, energy and recovery capacity. Their decline with age is not an immutable destiny: it is a treatable biomarker.
Free testosterone (men): drops 1-2% per year after age 30. Low levels are associated with muscle loss, increased visceral fat, fatigue, depression and higher mortality. Target: 12-15 ng/dL free testosterone, with total testosterone above 500 ng/dL.
Oestradiol (women): the decline during perimenopause and menopause accelerates bone loss, increases cardiovascular risk and impairs cognitive function. The ELITE trial (Hodis et al., NEJM, 2016, PMID: 26927946) demonstrated that hormone therapy initiated within the first 6 years after menopause had protective effects on coronary arteries. At Progevita, the Women's Vital Path programme includes a complete hormonal profile and follow-up plan.
Thyroid (TSH, T3, free T4): subclinical hypothyroidism is common and often undiagnosed. It causes fatigue, weight gain, constipation and brain fog. Optimal TSH for longevity: 1.0 – 2.5 mIU/L (not just "within range").
9. Body composition — beyond the scales
The scales don't distinguish between fat, muscle, bone and water. You can weigh the "right" amount and still have too much visceral fat and too little muscle — what's known as "normal weight obesity" or skinny fat. It's a high metabolic risk profile that goes undetected in conventional check-ups.
The two markers that matter:
Muscle mass: sarcopenia (age-related muscle loss) is one of the main predictors of frailty, falls, fractures and loss of independence. After 30, you lose 3-8% of muscle mass per decade if you don't resistance train. Maintaining it is an absolute priority for longevity.
Body fat percentage: more important than BMI, which doesn't distinguish composition. Guideline targets: men 10-20%, women 18-28%. Visceral (abdominal) fat is the most dangerous: it secretes inflammatory cytokines and is associated with insulin resistance, fatty liver and elevated cardiovascular risk.
How it's measured: multi-frequency bioimpedance or DEXA. At Progevita we use a Tanita multi-frequency bioimpedance device that segments muscle mass, fat and water by region. It's included in all programmes.
10. Epigenetic age — the biological clock
All the previous biomarkers measure specific functions. Epigenetic clocks attempt to answer the direct question: how fast are you aging?
They work by measuring DNA methylation patterns — chemical marks that accumulate or are lost at specific positions in the genome as we age. Different clocks measure different things:
| Epigenetic clock | What it measures | Target | Reference |
|---|---|---|---|
| Horvath Clock | General biological age | ≤ chronological age | Horvath, Genome Biology, 2013 |
| GrimAge | Mortality risk | ≤ chronological age | Lu et al., Aging, 2019 (PMID: 30669119) |
| PhenoAge | Biological frailty | ≤ chronological age | Levine et al., Aging, 2018 |
| DunedinPACE | Current pace of aging | < 1.00 (ideal: 0.85 – 0.95) | Belsky et al., eLife, 2022 |
GrimAge has proven to be the most predictive of all-cause mortality (Hillary et al., J Gerontol A, 2021, PMID: 33211845). DunedinPACE measures something different and complementary: not your accumulated biological age, but how fast you're aging right now. A DunedinPACE of 1.00 means you're aging one biological year for every calendar year. Below 1.00, you're aging more slowly. Above, faster.
What's promising about these tests is that they respond to interventions: changes in diet, exercise, sleep and stress can shift the clock within months. They're expensive (€200-500) and still evolving, but they represent the most advanced frontier of what we can measure.
Summary table: the 10 longevity biomarkers
| Biomarker | What it evaluates | Optimal target | Frequency | Available at Progevita |
|---|---|---|---|---|
| VO₂max | Cardiorespiratory fitness | M: ≥ 40, W: ≥ 35 mL/kg/min | Annual | Yes |
| Grip strength | Neuromuscular function | M: ≥ 40 kg, W: ≥ 25 kg | Quarterly | Yes |
| HbA1c | Glycaemic control | 4.8 – 5.4% | Every 6 months | Yes |
| hsCRP / suPAR | Chronic inflammation | hsCRP < 1.0 mg/L | Every 6 months | Yes |
| ApoB | Cardiovascular risk | < 90 mg/dL | Annual | Yes |
| Vitamin D | Immunity and bone metabolism | 40 – 60 ng/mL | Every 6 months | Yes |
| Homocysteine | Methylation | < 8 µmol/L | Annual | Yes |
| Hormones | Hormonal balance | Age and sex-specific | Annual | Yes |
| Body composition | Muscle mass vs fat | M: 10-20% fat, W: 18-28% | Quarterly | Yes |
| Epigenetic age | Pace of aging | ≤ chronological age | Annual | Under evaluation |
How to use this information: measure, act, repeat
A biomarker is only useful if you do something with it. The cycle is simple:
1. Measure: get your baseline. At Progevita, the Optimization programme includes VO₂max assessment, body composition, strength testing, full blood work and medical consultation. It's the starting point.
2. Interpret: knowing the number isn't enough. You need to understand what it means in your context: age, sex, history, goals. That's why every programme includes a medical consultation where results are interpreted and a plan is designed.
3. Intervene: the four main levers are exercise (especially strength and zone 2 cardio), nutrition (real food, sufficient protein, cut processed food), sleep (7-8 hours, chrono-regulation) and stress management. Some interventions are medical: ozone therapy, NAD+ infusions or plasmapheresis can move specific biomarkers measurably.
4. Re-measure: every 3-12 months depending on the biomarker. Did your VO₂max improve? Did your hsCRP drop? Did your muscle mass increase? Without re-measurement, you're navigating blind.
This approach — measure, act, repeat — is exactly what sets a longevity clinic apart from a conventional medical check-up. The check-up tells you if you're already ill. Longevity biomarkers tell you if you're heading that way and what you can do to prevent it.
Frequently asked questions
What are longevity biomarkers?
They are objective measurements — from blood, physical performance or epigenetics — that predict healthy lifespan (healthspan) more accurately than chronological age. They include tests such as VO₂max, HbA1c, inflammation markers, lipid profile and body composition, among others.
What is the most important biomarker for longevity?
VO₂max has the strongest evidence as a predictor of all-cause mortality. A 2018 study in JAMA Network Open with 122,007 people showed that the highest aerobic fitness was associated with 5-fold lower mortality risk. But no single biomarker tells the whole story: ideally you should measure several complementary ones.
How much does it cost to measure longevity biomarkers?
A full blood panel with lipid, metabolic, hormonal and inflammatory markers costs between €150 and €400 depending on the markers. A VO₂max test costs around €140 and body composition by bioimpedance around €55. Epigenetic tests range from €200 to €500. At Progevita, programmes include the main diagnostics from €1,350, with accommodation, meals, treatments and a 12-month follow-up plan.
How often should I measure my biomarkers?
It depends on the marker. Body composition and strength every 3 months. Blood markers (HbA1c, hsCRP, lipid profile, hormones) every 6-12 months. VO₂max once a year. Epigenetic clocks once a year or every 2 years. The important thing is to establish a baseline and then compare against yourself.
Can I improve my longevity biomarkers?
Yes, and in many cases significantly. VO₂max can improve by 15-20% with 12 weeks of zone 2 cardio training plus intervals. HbA1c drops quickly when you reduce processed food and add fasting windows. hsCRP responds to an anti-inflammatory diet and regular exercise. Grip strength improves with resistance training. Even epigenetic clocks have been shown to respond to lifestyle changes within months.
How does Progevita measure longevity biomarkers?
Every programme includes body composition assessment (Tanita bioimpedance), grip strength, blood pressure and medical consultation. The Optimization and Leadership Path programmes add VO₂max with cardiopulmonary exercise testing. The Inflammaging and Women's Vital Path programmes include suPAR and Oxytest. Blood tests can be taken before, during or after your stay. Everything is integrated into a personalised 12-month plan.
What is the difference between biological and chronological age?
Chronological age is the number of years you've lived since birth. Biological age is how aged your body actually is, measured by functional and epigenetic biomarkers. Two people who are chronologically 50 can have biological ages of 40 and 60 respectively, depending on their habits, genetics and exposure history.
References
- Mandsager K et al., "Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing", JAMA Network Open, 2018 (PMID: 30382293)
- Leong DP et al., "Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study", The Lancet, 2015 (PMID: 25982160)
- Ridker PM et al., "Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease (CANTOS)", NEJM, 2017 (PMID: 28845751)
- Rasmussen LJH et al., "Association Between Elevated suPAR, a New Biomarker of Inflammation, and Accelerated Aging", J Gerontol A Biol Sci Med Sci, 2021 (PMID: 32710613)
- Sniderman AD et al., "ApoB, LDL-C, and non-HDL-C as markers of cardiovascular risk", Journal of Clinical Lipidology, 2025
- Lu AT et al., "DNA methylation GrimAge strongly predicts lifespan and healthspan", Aging, 2019 (PMID: 30669119)
- Hillary RF et al., "GrimAge Outperforms Other Epigenetic Clocks in the Prediction of Age-Related Clinical Phenotypes and All-Cause Mortality", J Gerontol A, 2021 (PMID: 33211845)
- Hodis HN et al., "Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol (ELITE trial)", NEJM, 2016 (PMID: 26927946)
- Eugen-Olsen J et al., "Soluble Urokinase Plasminogen Activator Receptor (suPAR) as a Biomarker of Systemic Chronic Inflammation", Frontiers in Immunology, 2021 (PMID: 34925360)
Want to know where your biomarkers stand? Book your consultation at Progevita and start by measuring.
This article is for informational purposes and does not replace medical consultation. Biomarkers should always be interpreted in clinical context by a qualified professional.