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Biomarker Baseline Protocol

Peter Attia's Biomarker Baseline tests what actually predicts cardiovascular and metabolic disease early. It centers on ApoB and Lp(a) once, plus fasting insulin, an oral glucose tolerance test and HbA1c, since ApoB better predicts atherosclerosis than LDL-C alone and Lp(a) is genetic and can reshape your whole strategy. Attia targets optimal, not merely normal, ranges, acted on with a physician.

BeginnerLongevityHeart

Not endorsed · based on the published work of Peter Attia

At a glance

Time

Quarterly

Steps

Difficulty

Beginner

ApoB counts the atherogenic particle number that drives atherosclerosis, a better predictor than LDL-C alone.

The protocol

Cardiovascular, once

Test Lp(a) one time A single Lp(a) test; it is largely genetic and stable for life (NIH cites optimal under about 14 mg/dL)

About 1 in 5 people carry elevated Lp(a); you cannot change it with lifestyle, but knowing it changes your strategy.

The Drive AMA #43

In your stack: Lp(a) blood test

Cardiovascular, ongoing

Track ApoB Discuss your target with a physician; longevity targets are stricter than standard (commonly under 90 for primary prevention, under 60 to 65 with risk factors)

Particle number, not just LDL-C, drives heart-disease risk.

The Drive AMA #43

⚠ ApoB beats plain LDL-C, but it does not clearly beat non-HDL-C on its own, the apparent advantage only shows up in a statistical model the study authors flagged for high collinearity. Discuss any change to lipid-lowering medication with your physician, not this number alone.

In your stack: ApoB / advanced lipid panel

Metabolic, early

Fasting insulin plus glucose (HOMA-IR) Attia favours fasting insulin well under about 5 to 8 uIU/mL; pair with glucose to compute HOMA-IR

Insulin resistance shows up years before HbA1c rises.

Outlive

In your stack: Fasting insulin + glucose panel

Metabolic, gold standard

Oral glucose tolerance test with insulin An OGTT that measures the insulin response, not just glucose (done at a lab)

The most sensitive early window into metabolic dysfunction.

The Drive

Metabolic

HbA1c Attia targets under 5.5 percent (vs the 6.5 percent diagnostic threshold)

A longer-term average of blood glucose.

Outlive

In your stack: HbA1c test

Continuous data

Wear a CGM for 2 to 4 weeks A continuous glucose monitor to see real responses to food, sleep and stress

Turns abstract numbers into behaviour you can change.

The Drive

In your stack: Continuous glucose monitor

Organs and inflammation

Round out the panel ALT (Attia optimal under 20 for women, under 25 for men), thyroid (TSH, free T3, free T4), vitamin D, homocysteine, hs-CRP, sex hormones, and kidney markers (cystatin C / eGFR)

Connects metabolic health to energy, cognition and body composition.

Outlive

In your stack: Comprehensive longevity blood panel

Function

Test VO2 max and get a DEXA scan A VO2 max test and a DEXA for body composition and bone density (clinic-based)

VO2 max is a top mortality predictor; body composition and bone matter as much as bloodwork.

The Drive

Act on it

Re-test and adjust with a physician Set a baseline, then re-check key markers about every 3 to 6 months as you change things

Data only helps if you act on it and re-measure.

Outlive

Measure your baseline

This protocol works from your actual levels. Testing partner coming soon.

Lp(a) blood test
ApoB / advanced lipid panel
Fasting insulin
Glucose panel
HbA1c test
Continuous glucose monitor
Comprehensive longevity blood panel

We may earn a referral fee if you book testing through a future partner link; it will never affect which tests are listed here. This is not medical advice or a diagnosis.

The evidence 4

ApoB counts the atherogenic particle number that drives atherosclerosis, a better predictor than LDL-C alone.

View sources

The Drive, AMA #43: apoB, LDL-C, Lp(a) and insulin as risk factors Read peterattiamd.com

Outlive: The Science and Art of Longevity (Attia, 2023) Read peterattiamd.com

2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia Read doi.org

Association of Apolipoprotein B With Cardiovascular Risk (Marston et al., JAMA Cardiology, 2022) Read pmc.ncbi.nlm.nih.gov

Not medical advice. This page is for education only and is not a substitute for professional medical care. Consult a qualified clinician before changing your health routine.
Independent curation. YourProtocol is an independent platform. This protocol is based on the publicly available work of Peter Attia and is not created, reviewed, endorsed by, or affiliated with Peter Attia or Early Medical.

Is this for you

Anyone who wants a real baseline instead of normal labs
People with a family history of heart disease (Lp(a))
Data-driven people who will act on the numbers

Cautions

Attia is diagnostics-first and sells no supplement line; the few supplements he personally uses (omega-3, vitamin D, magnesium) he sources from Momentous and AG1. The equipment and lab tests here are generic recommendations ordered through a physician or lab, not his products
This is education based on Attia's published work, not medical advice or a prescription; interpret and act on results with a licensed physician
ApoB targets and any lipid-lowering therapy (statins, ezetimibe, PCSK9 inhibitors) are physician decisions; no drug doses are given here and no medications are sold
Some tests (OGTT, VO2 max, DEXA) are done at a clinic or lab
Reference ranges vary by lab; optimal targets are stricter than standard cutoffs and should be discussed with your doctor

Common questions

Is ApoB better than LDL cholesterol?

ApoB counts the number of artery-clogging particles directly, while LDL-C only estimates the cholesterol carried inside them. A 389,529-person UK Biobank study found ApoB predicts cardiovascular risk better than LDL-C, though the advantage over non-HDL-C is smaller and depends on how the comparison is modeled. See our full ApoB explainer for the complete picture.

What ApoB level does Peter Attia target?

Attia targets optimal, not merely normal, ranges and discusses commonly under 90 mg/dL for primary prevention and under 60 to 65 mg/dL with risk factors, decided with a physician. Lab reference ranges include many people who go on to have cardiac events, so normal and optimal are not the same thing.

Does ApoB clearly beat non-HDL-C?

Not clearly. In the largest head-to-head study, ApoB only outperformed non-HDL-C in a statistical model combining all three lipids at once, a model the authors themselves flagged for high collinearity. Tested individually, the two performed almost identically.

Do I need to fast before an ApoB test?

No. ESC/EAS guidance is explicit that fasting is not required for ApoB, since post-meal chylomicron particles are under 1% of circulating ApoB.

Will my doctor order ApoB automatically?

Usually not. It's typically ordered separately from a standard lipid panel, and insurers sometimes deny or require prior authorization for it.

Does a high ApoB mean I will definitely develop heart disease?

It's linked to risk and is the strongest single lipid predictor studied, but genetic studies cannot fully separate ApoB's effect from the cholesterol it carries, so the honest phrasing is 'linked to,' not 'causes.'

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