Qualy #6 - What are the best lab tests to request specifically for longevity

**Peter Attia** (0:05)
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**SPEAKER_1** (1:05)
If you want to get into like, if you could actually measure some things for longevity, but you really can't in a lab test that you would want to look at.

**Peter Attia** (1:12)
So if we're talking longevity purely in terms of lifespan, how long, you know, looking at someone's blood, can you get a sense of how long until they're going to die?
The way to think about that. So what you're not going to get on a standard blood test is any of the longevity genes. I mean, you can get some of them, but certainly APOE would be one of the longevity genes. LP little a would be a longevity gene in inverse, so the lower your LP little a, the greater your chance of cardiovascular mortality. So the way I really think about longevity in blood is the three things that you're looking for in blood disease-wise are, what is this person's risk of atherosclerotic disease? So heart disease or stroke? What is this person's risk of cancer? What is this person's risk of neurodegenerative disease? So as you march down those things, you would say, well, cardiovascular disease largely driven by three things, lipoproteins, inflammation, endothelial dysfunction. How much of that can we see in blood? Actually a lot. On the lipoprotein side, we can see most of what we want, which is the Lp, the LDL, the small LDL, I'm talking particle number, not cholesterol, and the VLDL as alluded to. On the inflammation side, we can see specific and nonspecific markers of inflammation. So on the nonspecific side, we can see things like fibrinogen, C-reactive protein. On the specific side, you can see things like ox LDL, LpPLA2, ox phospholipid, those things. Very helpful. Endothelial health is the hardest thing to see, but I include insulin here because I think that insulin is in and of itself actually toxic at high levels to the endothelium. And James O'Keefe just recently was on a paper that looked at cardiovascular health in patients with type 1 diabetes so that they were able to actually use the insulin doses that people were using as a way to actually assess the impact on the, I can't remember if it was myocardium or endothelium.
You can look at things like homocysteine. We also look at something called asymmetric dimethylarginine or ADMA and SDMA, which are inhibitors of nitric oxide synthase. So the way I tell patients is the younger you are, the more your blood tells me about your risk of cardiovascular disease. So a 40-year-old person who otherwise doesn't have some dramatic LP little a through the roof or something crazy, the blood tells me probably 80, 85% of what I need to know. The older a patient gets, the more I would probably rely on things like CT angiograms or even, usually by the time they're older, a calcium score becomes less relevant. Calcium score can be somewhat helpful in a younger patient, though. But the latest study I saw, which actually just was an editorial that came out two days ago based on a study in one of the atherosclerosis journals, was looking at 50% of patients that had events had them at the site of non-calcified lesions. Not a huge vote of confidence for why a low calcium score is that helpful.
On the cancer side, I think that's really frankly where blood gives us the least insight. Until companies like Grail have fully functioning liquid biopsies where you're looking at, I think Grail's probably looking mostly at RNA and DNA. Other companies have looked at circulating proteins. But until these liquid biopsies are there, we don't really have much insight into it. Also, virtually every cancer is a result of a somatic mutation, not a germline mutation. So knowing your genotype doesn't really help outside of a few outlier things like BRCA or Lynch.