Five markers that best predict long term longevity

Longevity has turned into a race to collect biomarkers. Biological clocks, telomere length, high sensitivity CRP. The list feels endless and, worse, many measurements do not tell you what to do tomorrow. In a conversation between Barbell Medicine physicians, a more practical idea came up: if you had to pick only five markers to guide decisions, which ones would you choose?

They called it the vital 5. It is not a magic recipe, it is a framework: pick metrics that have a clear relationship with risk over time and that you can improve with habits and, when needed, clinical support. The five are blood pressure, apolipoprotein B (apoB), VO2 max, relative strength, and a body composition indicator they referred to as the body roundness index.

Why five markers are enough to start

The goal is not to find a perfect number, but to understand two ideas. First, many risks depend on dose and on time: it is not only how high a marker gets, but how long it stays there. Second, context matters. You do not manage blood pressure the same way for a young person trying to maximize long term health as you do for someone with multiple conditions or in hospice care.

With that lens, the vital 5 acts like a minimum viable panel. It gives you a map of cardiovascular risk, cardiorespiratory capacity, muscle reserve, and fat distribution. From there, you can prioritize.

1) Blood pressure: lower for longer

From a prevention standpoint, the message was clear: for most people, you should not be permissive with readings above 120/80 unless there is a specific reason. Blood pressure is not only a diagnosis, it is an exposure. If you spend decades in the elevated range, you pay for the cumulative stress on your vessels.

How to make it real:

• Measure at home with a validated cuff. Sit for five minutes, arm supported at heart level, take two readings, and log the average.
• Look for consistency, not a single day number. Repeat at different times across the week.
• Act on the basics: less alcohol, more daily movement, better sleep, less sodium if your diet is heavy in ultra processed foods, and weight adjustment if you carry excess.

If your blood pressure remains high despite that, the next step is a clinician guided plan. The point is not to collect medications, it is to reduce exposure.

2) ApoB: your atherogenic load in one number

If blood pressure is the force pushing on your arteries, apoB is closer to a count of particles that can enter the arterial wall and build plaque. In the episode, it was framed as a way to summarize your atherogenic load with a single test.

Again, dose and time show up. The higher it is and the longer it stays elevated, the greater the probability of cardiovascular disease. Practically:

• Ask for apoB on your next lab panel if your goal is long term prevention.
• Interpret it with your overall risk, family history, and other lipids. A single number matters less than a trend.
• Prioritize changes that often move it: more fiber, less saturated fat when it is a major excess, more training, and more movement across the day.

Lipoprotein(a) was mentioned as a possible addition. It can matter, but if you have to pick five, they favored apoB because it represents most relevant particles and because targeted therapies for Lp(a) are still being validated.

3) VO2 max: measurable aerobic capacity

VO2 max is not only for athletes. It reflects how well you transport and use oxygen, and it is tightly linked to survival and quality of life. The useful part is that it can be trained and it can be estimated with lab testing or reasonable field tests.

To apply it:

• Choose one consistent measurement method. If you can do a masked lab test, great. If not, use a repeatable protocol on a bike, treadmill, or a running test.
• Build an aerobic base with steady moderate sessions and add intervals as you tolerate them.
• Retest periodically and track the trend. You want progress, not comparison.

4) Relative strength: function over ego

Absolute strength can mislead. The point is not total weight moved, but functional capacity relative to your body. They debated whether grip strength or a one rep max tells enough and landed on the need for a test that reflects muscle and nervous system integration.

A practical approach:

• Pick one main strength metric you can repeat with good technique: pull ups, a squat at a bodyweight based ratio, a deadlift at a reasonable multiple, or a fixed load repetition test.
• Train strength two to four days per week with simple progression. Keep some unilateral work and mobility so the movement stays solid.
• Avoid tests that are too late stage for young healthy people, such as sit to stand, which often becomes abnormal when the problem is already advanced.

5) Body roundness index: composition and distribution

For body composition, they rejected BMI as the only metric. Waist helps, but it does not capture everything. The proposed body roundness index tries to summarize not only how much fat you carry, but where it sits, which is more closely tied to metabolic risk.

How to use it without obsession:

• Measure waist and height with a tape in the same spot each time.
• Treat it as a trend signal. If it worsens, revisit habits, sleep, activity, and nutrition.
• If you ever get imaging like CT or MRI to quantify visceral fat, understand the context. CT involves radiation and is rarely needed for curiosity alone.

An uncomfortable extra: social health

They ended with a marker that does not fit on a lab slip. How many friends you can call and have them pick up. When you last went outside. It sounds like a joke, but it is a reminder that longevity is not only physiology. If your vital 5 is perfect but daily life is isolated, something is off.

Conclusion

If you want an actionable starting point, measure less and measure better. Use the vital 5 to decide what to change first, review trends, and adjust over time. Longevity is built through consistency, not an endless list of tests.