Not just LDL cholesterol: Here are 6 biomarkers that can predict longevity

Surviving longer and remaining healthier in later life is influenced by many factors beyond classical blood lipids. A growing body of clinical research shows that simple physiological, functional and biochemical markers often outperform single lipid measures for predicting all-cause and cardiovascular mortality.
​Biomarkers, or biological markers, are measurable indicators of a biological state or process in the body. These are health signals that reflect how well different organs, systems or metabolic pathways are functioning. Clinically, biomarkers are useful because they help predict disease risk, monitor how health is changing over time, and often provide early warnings long before symptoms appear. Modern research increasingly shows that certain lifestyle-linked biomarkers offer powerful insight into one’s biological age and long-term survival.

VO₂ max is the maximum rate at which the body can take up, transport and use oxygen during intense exercise. It’s measured directly with metabolic gas analysis during graded exercise testing or estimated from treadmill/bike protocols, submaximal tests or validated prediction equations.
Large cohort and meta-analytic studies consistently show higher VO₂ max (or higher cardiorespiratory fitness) is associated with markedly lower all-cause and cardiovascular mortality.
Better VO₂ max reflects integrated health of the heart, lungs, vasculature, muscle mitochondrial capacity and autonomic balance.
How to improve VO2 max: Small, consistent increases in weekly moderate-vigorous activity raise VO₂ max and lower mortality risk.

Handgrip strength (kg) is measured with a dynamometer. It’s a simple, inexpensive proxy for overall muscle strength and function.

Note: Cutoffs vary by age, sex and population.
An umbrella review and multiple meta-analyses show lower grip strength predicts higher all-cause mortality, cardiovascular events, disability and hospitalisation across age groups and settings. Grip strength predicts outcomes independently of many traditional risk factors, and threshold/dose-response relationships have been reported: weaker individuals have meaningfully higher mortality risks.
How to improve: Resistance (strength) training focusing on major muscle groups, progressive overload, adequate protein intake and addressing sedentary behaviour. Even modest gains in strength associate with better survival outcomes in observational studies.

Resting heart rate is the number of beats per minute measured at rest. It can be measured by a clinician, with wearable devices or manually.
Multiple cohort studies and meta-analyses show higher resting heart rate predicts increased all-cause and cardiovascular mortality.
How to improve: Aerobic training and improved fitness lower resting heart rate. Stress management, sleep, weight loss and avoiding stimulants can help. Clinicians evaluate persistent high RHR to rule out secondary causes.

Estimated glomerular filtration rate estimates kidney filtration function from using equation serum creatinine. eGFR is reported in mL/min/1.73 m².
Longitudinal studies show that people with chronic kidney disease (CKD) or progressive eGFR decline have higher mortality and CVD event rates compared with those with preserved kidney function. The relationship is continuous: lower eGFR generally corresponds to higher risk, though age and comorbidities modify effect sizes.
How to slow decline: Blood pressure and diabetes control, SGLT2 inhibitors in appropriate patients, RAAS blockade when indicated, addressing nephrotoxins (NSAIDs), maintaining healthy weight and avoiding smoking. Early detection via routine labs helps risk stratification and intervention.

High-sensitivity C-reactive protein is a sensitive blood test measuring low-grade systemic inflammation. It’s measured by immunoassay.
Elevated hs-CRP is associated with higher risk of cardiovascular events and mortality in population studies and in patients with suspected acute coronary syndromes. Large observational cohorts and analyses show graded relationships between higher hs-CRP and worse long-term outcomes, independent of traditional risk factors.
How to lower hs-CRP: Lifestyle: weight loss, dietary improvements (Mediterranean pattern), smoking cessation, regular physical activity and controlling metabolic disease can help.

Waist circumference divided by height is a simple index of central (visceral) adiposity and is often a better predictor of cardiometabolic risk than BMI. WHtR can be measured through a simple string test.
Cohort studies show higher WHtR is associated with higher all-cause and cardiometabolic mortality. Meta-analyses indicate WHtR performs equal or better than BMI and waist circumference alone for predicting cardiometabolic outcomes and death in many populations.
Note: Thresholds may vary by age and ethnicity.
How to improve: Weight loss focused on reducing visceral fat (combination of caloric control and physical activity, both aerobic and resistance training), reducing processed food and added sugars, improving sleep and stress control.

Since these biomarkers tap distinct, and partly overlapping, pathways , combined assessment yields a richer picture of biological age and mortality risk than any single measure. Many cohort studies use multi-marker models and find improved prediction when functional (fitness/strength), anthropometric and biochemical markers are combined.

Relying on a single biomarker, whether LDL cholesterol, BMI or resting heart rate, captures only one dimension of health, which can miss early physiological changes occurring elsewhere in the body. In contrast, using a panel of diverse biomarkers provides a far more accurate and holistic picture of biological aging and long-term risk. This integrated approach helps identify risk earlier, guide more personalized interventions and track meaningful improvements across multiple physiological domains, ultimately improving both lifespan and healthspan.

To manage cholesterol, focus on a heart-healthy lifestyle: eat a diet rich in fruits, vegetables, whole grains, and healthy fats while limiting saturated and trans fats. Exercise regularly, maintain a healthy weight, avoid smoking, and limit alcohol. Regularly monitor cholesterol levels, and follow your doctor’s advice—medications like statins may be prescribed if lifestyle changes aren’t enough.