Table of Contents:
1. Apo-B
2. Lp(a)
3. APOE Genotype
4. OGTT
5. CMP
6. Liver Function
7. Kidney Function
8. hs-CRP
9. Ferratin
10. Homocysteine
11. Vitamin D

Peter Attia is a renowned doctor and public health educator specializing in preventive medicine and maximizing healthspan—the length and quality of life—for his wealthy clientele.

For Peter, understanding your bloodwork is one of the most powerful ways to assess baseline health and identify the interventions or lifestyle changes needed to enhance healthspan.

Before diving in, it's worth noting that Peter dislikes the idea of a one-size-fits-all "best" blood tests. The ideal panels depend on your unique circumstances—health history, goals, age, and more. However, if pressed to choose, these are the five blood tests he would recommend. I’ve also expanded the list with six additional tests Peter commonly uses with his patients [source]. 

To make it easier for you to interpret your results, I’ve created a free Google Sheet where you can input your blood test data and compare it to Peter’s ideal values.

This sheet is a Free Download and you can go to File -> Make Copy so you can have your own copy via Google Sheets.

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Peter Attia's Top 5 Blood Tests – If Forced to Choose 

1. ApoB

For Peter the best blood test to assess one's lipid profile is ApoB, which is short for apolipoprotein B. This test helps understand a patient's atherogenic risk as it directly measures the number of atherogenic lipoprotein particles in the blood and provides a more accurate assessment of the potential for plaque buildup in ones arteries.

In a standard lipid panel the best proxy for ApoB would be LDL but Peter prefers ApoB which usually costs ~$35 if buying your own labs. LDL has typically been used to assess cardiovascular risk, however,  it doesn't give a complete picture of the particles driving plaque formation in the arteries which makes it a worse predictor of risk than ApoB.

In reality Peter would also be testing LDL, HDL, triglycerides and other things on the standard lipid panel but if forced to choose only 5 blood tests would lean on ApoB due to its unique ability to measure the full burden of atherogenic risk.

Optimal Ranges

ApoB: Less than 65 mg/dL is ideal and Peter often shoots for the 30-40 mg/dL range with his patients

Peter is a big believer in aggressively lowering ApoB to reduce or even eliminate the risk of Atherosclerotic Cardiovascular Disease (ASCVD). This is one of the 4 horsemen diseases from his book Outlive (Check Out My Summary) that are responsible for a majority of deaths and his philosophy is to greatly reduce or eliminate this horseman from play.

Intervention Options

I’m not going to fully dive into details in this article but wanted to provide a few options to research if looking to reduce your ApoB and cardiovascular risk. These will have various efficacies and are listed as a primer for a conversation with your healthcare provider.

1. Exercise
2. Reduce carbohydrates to lower triglycerides
3. Reduce saturated fat in diet to decrease cholesterol synthesis
4. Increase Fiber intake - especially soluble forms
5.. RX Drugs: Stains, PSK9 inhibitor, ezetimibe, and bempedoic acid 

2. Lipoprotein(a) - Lp(a)-P Test

Lipoprotein (a) is a cholesterol carrying particle linked to heart disease. Elevated Lp(a) levels are a major risk factor for atherosclerosis, a condition where plaque builds up in arteries. Peter would want to know your Lp(a) because of the unique risk that elevated levels carry and the fact that Lp(a) is not tested in a standard lipid test. The good news is we only needs to test your Lp(a) once to check you do not have elevated levels that may require special treatment. 

Optimal Range

Less than 14 mg/dL is ideal but >50 is considered high risk and would warrant more aggressive treatment

Intervention Options

1. Exercise and a healthy lifestyle
2. New drugs are in development to target Lp(a) and are in phase 3 trials
3. PSK-9 Inhibitors help reduce Lp(a) by about 20-30%

3. APOE Genotype Test

APOE genes play a role in lipid metabolism and influence the risk of Alzheimer’s disease. This test identifies which combination of APOE alleles you carry, offering a personalized snapshot of your risk profile.

This, like Lp(a), only needs to be tested one time and provides important information about one's risk of dementia and to a lesser extent cardiovascular disease. Peter and others stress that although carriers of APOE 4 face higher Alzheimer disease risk (up to 14.9 times for ε4/ε4 genotypes [source]) there are proactive strategies that can be taken to mitigate this.

If you happen to have done some genetic testing from 23andMe or others you likely already have your APOE genotype through the raw data or health reports like “Late-Onset Alzheimer's Disease” from 23andMe.

4. Oral Glucose Tolerance Test (OGTT)

The OGTT evaluates how efficiently your body processes glucose, offering critical insight into metabolic health.

In reality Peter would likely prefer a Kraft test as this specifically measures both glucose and insulin over time and just has more data with our limited test quantity. An OGTT also gives fasting insulin/glucose for the first blood draw so you get these for free to really maximize our limited tests.

The reason an OGTT is the holy grail of metabolic health tests is that it shows how one's body processes glucose over time and this response curve is the best early indicator of diabetes or metabolic health issues.

Test Procedure

1. Be fasted for 8-12 hours
2. Provide a baseline blood sample
3. Consume 75 grams of glucose
4. Blood samples are taken every 30 minutes over 2-3 hours 

Optimal Ranges

Blood glucose over 200 mg/dL at the 2-hour mark indicates diabetes, 140-199 mg/dL pre-diabetes, and under 140 mg/dL is considered normal.

Peter's targets are more aggressive and latest I found was that he wants to see fasting glucose <100, glucose at 30min <140, glucose at 60min <130, and glucose at 120min <100

Alternative Test - HbA1c

An OGTT is harder to find so you may also want to consider hemoglobin A1c (HbA1c) which is more standard and doesn't require sitting in a lab for hours . This test gives an estimated average glucose over the past 90 days. However, Peter has written at length about why HbA1c can be misleading and he prefers to use HbA1c to look at changes over time after having an OGTT baseline for a patient. As a personal example my HbA1c is elevated from doing a lot of endurance training due to my body holding on to red blood cells longer.....I have a whole article to write about this finding.

Intervention Options

1. Exercise regularly
2. Maintain a healthy weight
3. Add muscle mass to act as glucose sponge
4. Sleep well and manage stress
5. Reducing simple carbohydrates and overall improve diet
6. RX drugs: Alpha-glucosidase inhibitors like Acarbose,  Biguanides like Metformin, GLP-1 agonists, and many others
7. Use a CGM to better understand your glucose response to foods and lifestyle factors. See my article on my experience with a CGM HERE

5. Comprehensive Metabolic Panel

For this last one Peter kind of cheated as a metabolic panel is actually measuring many things. This typically comes with red and white blood cell counts, hemoglobin information, and sometimes electrolyte levels.

Peter states his main goal for this last test would be to understand a patients liver function and renal function and in practice he would prefer to add on Cystatin C for renal function and a Liver function test with markers like AST, ALT, and GGT to check liver health.

Additional Blood Tests Peter Would Add

Let's go one step farther and I'm going to predict 6 additional tests Peter would want for any patient beyond these 5. These are all critical tests that Peter talks about regularly and are being measured on his patients. 

6. LFT - Liver Function test 

A LFT usually measures: ALP, ALT, AST, GGT, bilirubin and PT to give a comprehensive view of how the liver is doing. Elevated levels of these can indicate potential liver damage and are often tied to metabolic dysfunction

Optimal Ranges

• ALT: < 25 U/L
• AST <25 U/L
• Total bilirubin <1.2 (mg/dL)

7. Kidney Function Tests

These tests would include Cystatin C, Creatinine, eGFR, BUN, Albumin, and Electrolytes to give a comprehensive view of how one's kidneys are preforming.

The kidneys filter waste products from one's blood, regulate fluid and electrolyte balance, and produce urine. These tests can be a very early glimpse into compromised renal function and Peter believes that with increased prevalence of metabolic syndrome and diabetics this will only become more critical over time

Optimal Ranges

• Cystatin C <1.0 (mg/L)
• eGFR - Cystatin C >90 (mL/min/1.73m²)

8. hs-CRP (High-Sensitivity C-Reactive Protein)

hs-CRP measures systemic inflammation, a key driver of chronic diseases like heart disease, cancer, and neurodegeneration. Persistent inflammation is a warning sign that the body is under stress.

Optimal Ranges

• CRP<1.0 (mg/L)

9. Ferritin

Ferritin measures stored iron in the body. Both high and low levels can be problematic: excess iron contributes to oxidative stress, while deficiency leads to anemia and fatigue.

Optimal Ranges

• 30-400 (mcg/L)

10. Homocysteine

Homocysteine is an amino acid linked to cardiovascular and brain health. Elevated levels can damage blood vessels and increase the risk of Alzheimer’s disease.

Adequate intake of B vitamins (B6, B9, B12) can help lower homocysteine levels.

Optimal Ranges

• <9 (mcmol/L)

11. Vitamin D (25-Hydroxy Vitamin D)

Vitamin D plays a crucial role in immune function, bone health, and chronic disease prevention. Deficiency is widespread and linked to numerous health issues.

Lucky for us increased sun exposure and supplementation of vitamin D3 can increase levels. Getting tested multiple times to understand the right D3 dose to hit target blood levels may be needed.

Optimal Ranges

• 40-80 (ng/mL)

Key Takeaways

These five blood tests plus a few bonus ones can provide a roadmap to optimize your health and longevity. These tests all identify potential issues early on to allow you time to make changes that delay or prevent chronic diseases.

If you’re curious about diving deeper into these topics, consider exploring Peter’s work and as a start check out my SUMMARY of his book Outlive.

Related Articles:
1. Peter Attia's Outlive Book Summary
2. Peter Attia's Supplement Guide
3. How a CGM Changed my entire life
4. Andy Gilpin's Supplements for Athletic Performance

Sources:
1. https://www.youtube.com/watch?v=wVg9rc69UMs&ab_channel=PeterAttiaMD
2. https://peterattiamd.com/managing-gfr-high-blood-pressure/
3. https://peterattiamd.com/
4. https://peterattiamd.com/podcast/