120 to 160+ lab tests, explained.

ApoB (Apolipoprotein B) measures the total number of atherogenic (plaque-causing) particles in your blood — every LDL, VLDL, IDL, and Lp(a) particle carries exactly one ApoB protein. Standard LDL testing measures the cholesterol content carried inside particles, which can be misleading: someone with small, dense LDL particles can have a “normal” LDL-C while carrying a dangerous number of particles. Multiple large-scale studies, including INTERHEART and the Copenhagen City Heart Study, have confirmed ApoB is a superior predictor of cardiovascular events. Less than 5% of Americans get ApoB tested annually through their physician. Vitals Vault includes ApoB in the Advanced and Max plans, along with the LDL-C/ApoB ratio — a calculated value that reveals particle size and density.

The most clinically significant gaps between a standard annual physical and Vitals Vault’s comprehensive panel include: ApoB (superior cardiovascular risk marker, not on standard panels), Lp(a) (genetic cardiovascular risk factor affecting 1 in 5 people, rarely tested), fasting insulin (detects insulin resistance 10–15 years before HbA1c becomes abnormal), hs-CRP (high-sensitivity inflammation marker that predicts cardiac events independently of cholesterol), homocysteine (cardiovascular and cognitive risk marker), DHEA-S (adrenal hormone reflecting physiological aging), free testosterone and SHBG (total testosterone alone misses functional deficiency), Vitamin D 25-OH (deficient in ~42% of U.S. adults), thyroid antibodies TPO/TgAb (detect Hashimoto’s thyroiditis, which TSH alone misses), ferritin (iron storage, missed by standard iron tests), uric acid (metabolic and gout risk), and more than 80 additional biomarkers. The standard annual physical was designed for population-level triage, not individual health optimization.

Lipoprotein(a), or Lp(a), is a genetically determined cardiovascular risk factor that affects approximately 20% of the population — roughly 1 in 5 people. High Lp(a) independently doubles or triples the risk of heart attack and stroke, and unlike most cardiovascular risk factors, it cannot be meaningfully lowered through diet, exercise, or statins. The European Atherosclerosis Society and the European Society of Cardiology both recommend that every adult get Lp(a) tested at least once in their lifetime, since knowing your level early allows for aggressive management of all other modifiable risk factors. In the U.S., most physicians do not routinely order Lp(a) — it is not included in standard lipid panels. Vitals Vault includes Lp(a) in the Max plan.

Insulin resistance — where cells stop responding properly to insulin — precedes type 2 diabetes by an average of 10–15 years and is associated with weight gain, fatigue, cardiovascular disease, and hormonal disruption. The standard test (fasting glucose or HbA1c) doesn’t flag a problem until insulin resistance has been progressing for years. Vitals Vault’s Max plan includes fasting insulin, which detects insulin resistance directly; HOMA2-IR (Homeostatic Model Assessment of Insulin Resistance), a calculated ratio using insulin and glucose; HOMA2-%B (beta cell function) and HOMA2-%S (insulin sensitivity); QUICKI (quantitative insulin sensitivity check); and the TyG Index (triglyceride-glucose index, a proxy for insulin resistance) — all of which can reveal dysfunction years before glucose or HbA1c crosses the clinical threshold for prediabetes.

Chronic low-grade inflammation is a silent driver of cardiovascular disease, cancer, autoimmune conditions, cognitive decline, and accelerated aging — and it produces no noticeable symptoms in its early stages. Vitals Vault’s Inflammation & Immunity system tests hs-CRP (high-sensitivity C-reactive protein), Sed Rate (erythrocyte sedimentation rate), and Ferritin (also an acute-phase inflammation marker), plus a suite of calculated immune ratios that are emerging as powerful prognostic tools: NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), LMR (lymphocyte-to-monocyte ratio), SII (systemic immune-inflammation index), SIRI, and NLPR. These ratios provide a complete picture of immune balance and systemic inflammation that a single CRP value cannot capture.

Peter Attia, one of the most cited voices in longevity medicine, has publicly emphasized testing ApoB (calls LDL “a terrible metric” for cardiovascular risk), Lp(a) (recommends universal screening), fasting insulin and HOMA-IR (insulin resistance as a “four-alarm fire”), hs-CRP (systemic inflammation), homocysteine, Lp-PLA2 (arterial inflammation), testosterone and SHBG, cortisol patterns, Vitamin D, ferritin, uric acid, ALT (liver health), and eGFR (kidney function). Bryan Johnson’s Blueprint protocol also tracks DHEA-S, IGF-1, HbA1c, triglyceride ratios, and LDL particle number. Vitals Vault’s Max plan ($399) covers virtually all biomarkers from this longevity-focused list, including calculated ratios like the Atherogenic Index of Plasma (AIP) and TyG-BMI Index.

A standard CBC (Complete Blood Count) covers Blood Health only — white cells, red cells, and platelets. A standard comprehensive metabolic panel (CMP) covers basic kidney function, liver enzymes, glucose, and electrolytes. Together, they touch 2 of Vitals Vault’s 10 body systems — and only superficially. Vitals Vault organizes its full panel across: Blood Health (full CBC with differential), Energy & Metabolism (glucose, HbA1c, insulin resistance markers, biological age), Heart Health (full lipid panel plus ApoB; Lp(a) and homocysteine at Max tier), Hormonal Health (thyroid, testosterone, estradiol, SHBG; DHEA-S and cortisol at Max tier), Inflammation & Immunity (hs-CRP, sed rate, immune ratios), Kidney Health (BUN, creatinine, eGFR, electrolytes, uric acid), Liver Health (full hepatic panel including GGT, bilirubin ratios), Nutrients, Vitamins & Minerals (Vitamin D, B12, iron/ferritin, magnesium, folate), Pancreas Health (amylase, lipase — Max plan only), and Urine Analysis (full urinalysis). This is a fundamentally different scope than a routine physician workup.

Yes. Vitals Vault’s hormone panels are designed for both sexes equally. The Essential plan includes TSH and Total Testosterone for all genders. The Advanced plan adds Estradiol, SHBG (sex hormone-binding globulin), Free Testosterone, Bioavailable Testosterone, and calculated ratios including the T:E2 ratio and Testosterone/ApoB ratio. The Max plan adds DHEA Sulfate, Cortisol, Progesterone, IGF-1, and Z-Score. For women, estradiol, progesterone, and DHEA-S are as clinically important as testosterone is for men. Vitals Vault does not treat hormonal health as a gender-specific add-on — it is included across all tiers for all members.

Vitals Vault includes a significant library of calculated ratios not found on standard lab reports. These include: Atherogenic Index of Plasma (AIP) (log of triglycerides/HDL — a superior predictor of small, dense LDL and cardiovascular risk), TyG Index (proxy for insulin resistance), TyG-BMI Index, Glycation Gap (reveals discordance between HbA1c and average glucose), HOMA2-IR, HOMA2-%B, HOMA2-%S (insulin resistance and beta cell function — Max plan), LDL:HDL ratio, Triglyceride:HDL ratio (a proxy for particle size), Non-HDL/Total Cholesterol ratio, LDL-C/ApoB ratio (reveals particle density), AST:ALT ratio (De Ritis ratio for liver pathology pattern), BUN/Creatinine ratio (hydration and kidney function), NLR, PLR, LMR, SII, SIRI (immune balance ratios), and more. Ratios are powerful because they reveal relationships between biomarkers that individual values cannot — a triglyceride of 150 and HDL of 40 both look borderline acceptable individually, but a triglyceride/HDL ratio of 3.75 reveals significant insulin resistance and cardiovascular risk.