Last updated: February 2026 · Written by the Lola Health editorial team

Peter Attia Blood Tests UK: ApoB, Lp(a) & the Longevity Panel

How to replicate the Outlive author's recommended blood panel in the UK — and which markers actually matter for longevity.

Peter Attia has done more than almost any other physician to shift the public conversation around blood testing. His argument is straightforward: the markers your GP checks in a routine blood test were designed to detect disease that already exists. They were not designed to prevent it.

In his 2023 book Outlive: The Science and Art of Longevity and across hundreds of episodes of his podcast The Drive, Attia has laid out a different framework. He calls it Medicine 3.0 — an approach that treats longevity as an engineering problem, uses blood biomarkers as early-warning instruments, and intervenes aggressively decades before standard medicine would act.

The result is a comprehensive blood panel that goes well beyond the standard NHS lipid profile. This guide explains every marker Attia recommends, why he recommends it, and how to access these tests in the UK.

Who Is Peter Attia?

Peter Attia is a Canadian-American physician who trained in general surgery at Johns Hopkins Hospital before spending five years at the National Institutes of Health (NIH), where his research focused on immune-based therapies for melanoma. He subsequently spent two years at McKinsey & Company before founding Early Medical, a medical practice focused on the applied science of longevity.

His clinical approach draws on four pillars: exercise, nutrition, sleep, and emotional health — with blood biomarkers as the measurement system underpinning all four. He is not a laboratory scientist publishing primary research on these markers. He is a clinician who synthesises the existing evidence and applies it in practice, often more aggressively than mainstream guidelines recommend.

That distinction matters. Some of Attia's targets — particularly his ApoB threshold — go beyond current European Society of Cardiology (ESC) and NICE guidelines. Where his recommendations diverge from standard UK practice, we note it below.

The Peter Attia Longevity Blood Panel

The following table compiles the markers Attia has discussed across Outlive, The Drive podcast, and his written publications. They fall into seven categories: cardiovascular, metabolic, liver, kidney, hormones, nutrients, and cancer screening.

That is a panel of roughly 25 individual markers. In the UK, no single NHS blood test covers all of them. However, comprehensive private blood tests now cover the majority. We will address what is and is not available in the UK in a later section.

ApoB: Why Attia Calls It the Most Important Blood Test

If there is one message Attia has repeated more than any other, it is this: apolipoprotein B (ApoB) matters more than LDL cholesterol.

The standard lipid panel measures LDL-C — the amount of cholesterol carried inside LDL particles. But the actual driver of atherosclerosis is not the cholesterol itself. It is the particles that carry it. Each atherogenic lipoprotein (LDL, VLDL, IDL, and Lp(a)) carries exactly one ApoB molecule on its surface. Measuring ApoB therefore gives you a direct count of the total number of particles capable of entering the arterial wall and initiating plaque formation.

Two people can have identical LDL-C values but very different ApoB levels. The person with more particles — higher ApoB — has more "shots on goal" against the arterial endothelium. This is why large prospective studies and Mendelian randomisation analyses consistently show that ApoB is a stronger predictor of cardiovascular events than LDL-C.

Attia's ApoB targets

Attia has stated that he does not see a reason for anyone to have an ApoB above 60 mg/dL. That places his target at approximately the 5th percentile of the adult population — a level typically seen in children before decades of dietary and metabolic exposure raise it.

For patients he considers high-risk (family history, elevated Lp(a), existing plaque on coronary calcium or CT angiography), he pushes further, aiming for 20–40 mg/dL. Achieving levels that low generally requires pharmacological intervention — statins, ezetimibe, or PCSK9 inhibitors — on top of dietary changes.

How this compares to UK guidelines

NICE does not currently recommend routine ApoB testing. The NHS lipid pathway focuses on total cholesterol, LDL-C, HDL-C, triglycerides, and the total cholesterol/HDL ratio, combined with the QRISK3 cardiovascular risk calculator. The European Society of Cardiology has acknowledged ApoB as a secondary target, but it is not yet embedded in standard UK primary care workflows.

The good news: ApoB is now widely available through UK private blood testing services, including Lola Health. It is a straightforward immunoassay that requires no special preparation beyond a standard venous blood draw.

Lp(a): The Genetic Risk You Cannot Change But Must Know

Lipoprotein(a), abbreviated Lp(a) and pronounced "L-P-little-a," is one of the most underappreciated cardiovascular risk factors. Attia dedicated one of his earliest podcast episodes to it (Episode #7 of The Drive) and has returned to the topic repeatedly.

What makes Lp(a) different

Unlike every other marker on this list, your Lp(a) level is almost entirely determined by genetics. It is encoded primarily by the LPA gene, and your level is set at birth. Diet, exercise, and most medications do not meaningfully change it. Statins, in fact, can slightly raise Lp(a) levels.

Approximately 20% of the global population has elevated Lp(a) — typically defined as above 50 nmol/L (or above 50 mg/dL, though Attia recommends measuring in nmol/L for accuracy). These individuals carry a significantly increased risk of atherosclerotic cardiovascular disease (ASCVD), aortic valve stenosis, and potentially stroke, independent of their LDL-C or ApoB levels.

Why you only need to test it once

Because Lp(a) is genetically fixed, a single measurement is generally sufficient. If your level is low, you can set it aside. If it is elevated, that information reshapes your entire cardiovascular risk management strategy:

• More aggressive ApoB lowering. Attia argues that elevated Lp(a) is a reason to push ApoB even lower, because you cannot reduce the Lp(a) contribution to your total atherogenic particle burden.
• Earlier intervention. A 35-year-old with high Lp(a) may warrant statin therapy that would not be recommended under QRISK3 at that age.
• Family screening. If your Lp(a) is elevated, your first-degree relatives should also be tested.

New therapies on the horizon

For the first time, pharmaceutical companies are developing drugs that specifically lower Lp(a). Olpasiran (Amgen), lepodisiran (Eli Lilly), and zerlasiran (Silence Therapeutics) are all in late-stage clinical trials. These RNA-based therapies reduce Lp(a) by 90% or more. Phase 3 cardiovascular outcomes data is expected over the next few years. Attia has described this as one of the most exciting developments in cardiovascular medicine.

Until those drugs are approved, knowing your Lp(a) level still changes clinical decision-making. It is available through most UK private blood panels, including Lola Health's comprehensive tests.

Metabolic Health: Beyond HbA1c

Attia describes metabolic dysfunction — principally insulin resistance — as one of the "four horsemen" of chronic disease, alongside cardiovascular disease, cancer, and neurodegenerative disease. His approach to metabolic testing goes well beyond the standard HbA1c check.

Why he targets HbA1c below 5.5%

The NHS defines diabetes as HbA1c ≥48 mmol/mol (6.5%) and prediabetes as 42–47 mmol/mol (6.0–6.4%). Attia considers these thresholds far too late. By the time HbA1c reaches 6.0%, insulin resistance has typically been present for years.

His target for patients is an HbA1c below 5.5% (37 mmol/mol), with an ideal around 5.1% (32 mmol/mol). That corresponds to an average blood glucose of approximately 100 mg/dL (5.6 mmol/L) — meaningfully lower than the 140 mg/dL average that a 6.5% HbA1c implies.

He also acknowledges the limitations of HbA1c. It is a 3-month average, which means it can mask significant glucose variability. Two people with identical HbA1c values can have very different post-meal glucose spikes. This is one reason Attia advocates for continuous glucose monitors (CGMs), even in non-diabetic individuals.

The fasting insulin problem

Attia considers fasting insulin and the oral glucose tolerance test (OGTT) with insulin measurements far more informative than HbA1c alone. His key insight: hyperinsulinaemia — the body producing more and more insulin to maintain normal glucose levels — is the earliest detectable sign of metabolic dysfunction. He has called it "the canary in the coal mine."

By the time fasting glucose or HbA1c rises, the pancreas has often been compensating for years. Measuring fasting insulin catches the problem earlier.

The difficulty in the UK is access. Fasting insulin is not part of standard NHS testing, and even many private panels do not include it. HOMA-IR (the homeostatic model assessment of insulin resistance, calculated from fasting insulin and fasting glucose) is therefore also unavailable unless you specifically seek out a panel that offers it. This is one of the genuine gaps between Attia's ideal panel and what is practically available in UK private testing.

What Is Available in the UK vs. the USA

Attia practices in the United States, where direct-to-consumer blood testing is well-established and most specialist markers are readily available. The UK landscape is different. Here is a practical comparison.

The key takeaway: most of Attia's core panel — ApoB, Lp(a), HbA1c, hsCRP, liver enzymes, kidney function, thyroid, hormones, vitamin D, and ferritin — is available in the UK through comprehensive private blood tests. The genuine gaps are fasting insulin (and therefore HOMA-IR), cystatin C, RBC magnesium, and the omega-3 index. Of these, fasting insulin is the most clinically significant absence.

How Often Should You Test?

Attia treats blood testing as an ongoing monitoring programme, not a one-off event. His general framework:

• Annually (minimum): Every adult should have a comprehensive blood panel at least once per year. This establishes your baseline and allows you to track trends over time. A single blood test in isolation is far less useful than a series showing direction of travel.
• Twice per year: Attia recommends six-monthly testing for most of his patients, particularly those actively working on metabolic health, lipid management, or hormone optimisation. This frequency allows you to detect seasonal variation (vitamin D is typically lower in winter in the UK, for instance) and measure the impact of interventions.
• Quarterly: For patients on new medications (statins, testosterone replacement, thyroid medication), quarterly testing is used to monitor response and adjust dosing. This higher frequency is temporary — typically one to two cycles until levels stabilise.
• Once in a lifetime: Lp(a) and APOE genotype (if you choose to test it) only need to be measured once, as they are genetically determined and do not change.

The practical consideration in the UK is cost. Comprehensive blood panels are not cheap, and the NHS will not fund preventive testing at this frequency for asymptomatic individuals. However, the cost of a comprehensive private blood test is modest relative to the potential healthcare costs of undetected cardiovascular or metabolic disease. For most people, an annual comprehensive panel supplemented by targeted follow-ups is a reasonable starting point.

Liver Health: The Most Underdiagnosed Problem

Attia has described metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD) as the most underdiagnosed condition in developed countries. It is on track to become the leading indication for liver transplant within the next decade, and the vast majority of people with early-stage fatty liver have no symptoms whatsoever.

The standard liver function tests — ALT, AST, and GGT — are the first line of defence. But Attia takes a different view of what constitutes "normal."

Most NHS laboratories report ALT as normal up to 40–42 IU/L. Attia wants to see ALT below 20 IU/L. His reasoning: the reference range has drifted upward over the decades precisely because the population has become less healthy. An ALT of 35 IU/L is "normal" only in the statistical sense that most people have it. It does not mean the liver is optimally healthy.

If your ALT is consistently above 20 IU/L, particularly in the context of an elevated triglyceride-to-HDL ratio or insulin resistance, Attia would consider that grounds for further investigation — potentially an ultrasound or, ideally, an MRI with proton density fat fraction (PDFF) to quantify liver fat directly.

GGT is particularly useful because it is sensitive to both alcohol-related liver stress and metabolic liver disease, and elevated GGT has been independently associated with cardiovascular mortality in large cohort studies. It is one of those markers that earns its place on a longevity panel by offering information about multiple organ systems simultaneously.

Hormones: Testosterone, Thyroid, and DHEA-S

Attia includes a comprehensive hormone panel in his patient workups. His approach is pragmatic rather than ideological. He does not default to hormone replacement therapy, but he does take hormone levels seriously as functional biomarkers.

For testosterone, he emphasises free testosterone over total testosterone. Total testosterone can be misleadingly normal if SHBG (sex hormone-binding globulin) is high, because SHBG binds testosterone and renders it biologically inactive. Attia recommends that free testosterone should represent approximately 2% of total testosterone, and he always tests SHBG alongside total and free testosterone to interpret the results correctly.

He has been clear that symptoms matter more than numbers in the testosterone space. A man with a total testosterone of 400 ng/dL and significant fatigue, reduced libido, and cognitive fog is a different clinical picture than a man with the same level and no symptoms.

For thyroid, Attia tests TSH, free T3, and free T4. The NHS typically tests TSH alone as a screening tool and only adds free T3/T4 if TSH is abnormal. The problem with this approach is that subclinical thyroid dysfunction — where TSH is technically "in range" but the patient has symptoms — can be missed. Attia prefers a tighter TSH range of 0.5–2.5 mIU/L, versus the NHS reference range of approximately 0.27–4.2 mIU/L.

DHEA-S, the most abundant circulating steroid hormone, declines steadily with age. Attia tests it as part of his standard hormone panel, viewing it as a general marker of adrenal function and biological ageing. It is available through most UK private blood testing services.

Nutrients: Vitamin D, Ferritin, and Magnesium

Vitamin D is arguably the most relevant nutrient marker for UK residents. The UK's latitude means that between October and March, UVB radiation is insufficient for meaningful cutaneous vitamin D synthesis. The NHS considers levels above 50 nmol/L (20 ng/mL) sufficient. Attia targets 100–150 nmol/L (40–60 ng/mL) — two to three times higher than the NHS floor.

Whether the higher target produces better clinical outcomes remains debated. Large randomised controlled trials (including the VITAL trial) have not consistently shown benefits of vitamin D supplementation for cardiovascular events or cancer in people who are not deficient. Attia's position is that maintaining levels in the 40–60 ng/mL range ensures you are not leaving any potential benefit on the table, and that the risk of supplementation at the doses required (typically 4,000–5,000 IU daily) is minimal. He takes approximately 5,000 IU per day himself.

Ferritin is a dual-purpose marker. Low ferritin indicates iron deficiency — common in menstruating women, vegetarians, and endurance athletes. But Attia also watches for high ferritin, which can signal iron overload (haemochromatosis, which affects approximately 1 in 200 people of Northern European descent), chronic inflammation, or liver disease. It is one of those markers where both ends of the range warrant attention.

Magnesium presents a testing challenge. Serum magnesium, which is what most blood tests measure, reflects only about 1% of total body magnesium. The rest is intracellular or in bone. This means serum magnesium can be normal even when intracellular stores are depleted. Attia prefers RBC (red blood cell) magnesium as a more accurate measure, but this test is not widely available in the UK. In practice, many clinicians (and Attia himself) take the pragmatic approach of supplementing magnesium broadly — he takes approximately 1,000 mg per day across multiple forms — and using serum magnesium primarily to rule out frank deficiency.

Frequently Asked Questions

Summary

Peter Attia's approach to blood testing represents a shift from reactive to proactive medicine. Rather than waiting for biomarkers to cross a diagnostic threshold, he uses them as early-warning instruments — catching cardiovascular risk through ApoB and Lp(a), metabolic dysfunction through insulin and HbA1c, liver damage through ALT and GGT, and nutritional deficiencies through vitamin D and ferritin, all years or decades before symptoms would appear.

His targets are, in many cases, more aggressive than standard UK guidelines. Whether that aggressiveness is justified will become clearer as long-term data accumulates. What is already clear from existing evidence is that ApoB is causally linked to cardiovascular disease, that Lp(a) is an independent and undertested risk factor, that insulin resistance is detectable long before diabetes is diagnosed, and that liver disease is massively underdiagnosed.

The practical barrier in the UK has historically been access. The NHS does not offer most of these markers in routine screening. But private blood testing has closed that gap for the majority of Attia's panel. A comprehensive test covering 70 biomarkers, including ApoB, Lp(a), HbA1c, hsCRP, full liver and kidney function, thyroid, hormones, and key nutrients, can now be done at home with a professional phlebotomist visit and results within two working days.

You do not need to adopt every element of Attia's framework to benefit from it. Even testing ApoB and Lp(a) once — two markers absent from the NHS lipid panel — gives you information that meaningfully changes your understanding of your cardiovascular risk. That is a low-cost, high-value starting point.

Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Blood test results should be interpreted in the context of your individual health history by a qualified healthcare professional. Peter Attia's targets may not be appropriate for every individual. Always consult a doctor before starting or changing any medication.