Biomarkers worth tracking after 45

How we chose these markers

A marker earns a place on this list when it is linked to an important outcome, such as heart attack, stroke, diabetes or kidney failure, and when acting on it is known to help. That is why blood pressure ranks above many fashionable tests: treating high blood pressure clearly reduces strokes and heart attacks.

We lean on recommendations from the U.S. Preventive Services Task Force and the American Heart Association and American College of Cardiology, and note where guidance has changed recently.

The core list

• Blood pressure: the USPSTF recommends screening all adults, yearly from age 40, with home or ambulatory readings to confirm a diagnosis
• LDL cholesterol and non-HDL cholesterol: the backbone of heart risk assessment
• ApoB: counts the cholesterol-carrying particles that drive plaque; the 2026 ACC/AHA guideline includes it for selected people
• Lipoprotein(a): largely inherited; the 2026 ACC/AHA guideline recommends measuring it at least once in all adults
• A1c or fasting glucose: the USPSTF recommends screening adults 35 to 70 with overweight or obesity, about every three years if normal
• Kidney function: creatinine-based eGFR, plus urine albumin if you have diabetes or high blood pressure
• Waist circumference: a simple measure of abdominal fat that BMI can miss

Markers that depend on your situation

• hs-CRP: can refine heart risk; the 2018 AHA/ACC guideline treats 2.0 mg/L or higher as a risk enhancer when measured
• Ferritin and a blood count: when fatigue, hair shedding, heavy periods or restless legs suggest iron deficiency
• TSH, with free T4 if needed: when symptoms suggest thyroid disease
• Morning testosterone: for men with symptoms of deficiency, confirmed on two separate days
• Vitamin B12: with long-term metformin or acid-suppressing medicines, or nerve symptoms
• Liver enzymes: with alcohol use, fatty liver risk or certain medications

Tests with weaker evidence for routine use

Some tests are popular but lack evidence that routine use in healthy people improves outcomes. The USPSTF found insufficient evidence to add hs-CRP or coronary calcium scoring to routine heart risk assessment for everyone, even though both can help in selected cases. Biological age clocks, broad hormone panels in people without symptoms and large micronutrient panels fall into a similar category.

This does not mean these tests are worthless. It means you should know what decision each one would change before you order it.

Why midlife is the right time to look closely

Many of the conditions these markers detect develop silently over years. Blood pressure, blood sugar and cholesterol tend to rise through the 40s and 50s, and for women the menopause transition is often accompanied by a rise in LDL cholesterol. Men often accumulate abdominal fat and insulin resistance during the same years. Catching a trend early gives you time to change it with habits before medication becomes necessary, or to start treatment before damage accumulates.

Family history also comes into sharper focus in midlife. A parent or sibling with a heart attack or stroke at a young age, diabetes or kidney disease changes which markers deserve the most attention, and how early.

Simple measures you can take at home

Not every useful marker needs a blood draw. A validated upper-arm blood pressure cuff, a tape measure for your waist and a bathroom scale cover three important measures. Track them consistently: blood pressure at the same time of day after five minutes of rest, waist at the level of your navel after breathing out, and weight on the same scale at the same time of day.

How often to check

Frequency should match how fast a marker changes and how close you are to a treatment threshold. Lipoprotein(a) usually needs measuring once. A1c every one to three years is reasonable if normal. Lipids are often checked every few years when stable, or more often on treatment. Blood pressure can be checked at home regularly with a validated upper-arm cuff.

Reading results sensibly

Compare each result with the reference range on your own lab report, not one found online, and look for trends across tests done under similar conditions. A single borderline result is often repeated before anyone acts. And remember that a normal panel does not explain away symptoms; it simply rules some causes out.

Questions to ask your clinician

• Based on my history, which of these markers matter most for me?
• Have I ever had lipoprotein(a) measured?
• Should my blood pressure be confirmed with home readings?
• What is my estimated 10-year heart risk, and how would ApoB or a calcium score change it?
• When should each test be repeated?

Testing through HealifyMD

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