LONGEVITY LATEST ISSUE 23 · 12 AUGUST 2026
LONGEVITY LATEST
The Evidence-Based Edge on Living Longer and Better
Issue 23 · The Wrong Number · 12 August 2026
WELCOME
👋 Welcome
Your last blood test measured the wrong thing.
Not uselessly wrong. But the number your GP printed counts the cholesterol sitting inside the particles, and the disease is caused by the particles. For most people those two things agree. For a substantial minority they don't — and that minority skews hard towards people who have been told they're fine.
In March, the guideline that has governed cholesterol testing since 2018 was retired. Eleven organisations signed the replacement, and it instructs doctors to measure something in every adult, at least once, that almost nobody in Britain has ever had measured.
In this issue:
• 🔬 Top 3: the number that beat cholesterol in nine studies out of nine, the free one already on your printout, and the one you only ever need measured once
• ⭐ Spotlight: should you actually pay for an apoB test? My own result says something uncomfortable
• 🚨 Hype Check: the £299 panel, and the guideline that names its methods and says don't
• 📖 Deep Dive: why your test weighs the cargo when the damage is done by the lorries
THIS WEEK'S ANALYSIS
🔬 Top 3 Interventions Under the Microscope
Three numbers get graded, and all three come out well — which is unusual here, and shifts the question. It stops being whether they work and becomes which one you should actually pay for.
1. ApoB — Evidence Grade: A
What it is. Every particle in your blood that can cause plaque — LDL, VLDL, IDL, Lp(a) — carries exactly one molecule of apolipoprotein B. One particle, one apoB. So apoB counts the lorries. LDL cholesterol weighs what happens to be inside them that morning.
Human evidence. Marston's team took 389,529 statin-naive adults out of the UK Biobank and followed them a median of eleven years. Each standard deviation of higher apoB carried 38% higher risk of heart attack. Then the part that made me sit up: once apoB was in the model, LDL cholesterol and triglycerides stopped predicting anything at all. The same collapse showed up in FOURIER and IMPROVE-IT.
Sniderman's group has argued this for fifteen years and finally assembled the case properly. Their 2025 systematic review pooled fifteen discordance studies and 593,354 people — the design that deliberately isolates the people where two markers disagree. ApoB beat LDL cholesterol in nine studies out of nine.
Cautions. This is not a different disease, and for most people most of the time apoB and LDL cholesterol say the same thing. Nothing in that data makes apoB an annual test for everybody.
Takeaway. The most accurate single measure of the thing that actually builds plaque. Grade A. Whether you personally should buy one is a different question, and it gets its own section below.
2. Non-HDL cholesterol — Evidence Grade: A
What it is. Total cholesterol minus HDL. That is the whole method — arithmetic on two numbers already sitting on the printout. It captures the cholesterol in every apoB-carrying particle rather than LDL alone, and unlike LDL cholesterol it isn't estimated by an equation that misbehaves when triglycerides run high.
Human evidence. In the meta-analysis that started this argument — 233,455 people, 22,950 events — the standardised relative risk ratios came out at 1.43 for apoB, 1.34 for non-HDL and 1.25 for LDL cholesterol. Non-HDL sits closer to the expensive number than to the famous one. NICE has preferred it in Britain for a decade; NG238 sets targets against it, and it needs no fasting.
It costs nothing. It is on a piece of paper in your kitchen drawer. Most people reading this have never once looked at it.
Cautions. Sniderman's review is explicit that non-HDL is not an adequate substitute for apoB, and I won't soften that to make the free option sound better. It closes most of the gap. Most is not all, and the people it fails are the ones with high triglycerides — exactly the group who needed the better number.
Takeaway. Grade A, and free. This is the default. ApoB is the refinement you buy afterwards, if you turn out to be the sort of person it refines.
3. Lp(a), measured once — Evidence Grade: A
What it is. An LDL particle with a second protein welded to it. Between 80 and 90% genetically set, effectively fixed from your twenties, and completely unmoved by diet, exercise or statins. Roughly one adult in five carries enough of it to matter. This is the number the new guideline wants measured in everybody.
Human evidence. The Copenhagen population studies — north of 77,000 people — found heart attack and aortic stenosis risk climbing from about 30 mg/dL and roughly tripling above 90. Against which: across 5.5 million adults in six Californian health systems between 2013 and 2021, 0.3% had ever been tested.
Now the uncomfortable half. Nothing on the market lowers it. The drug furthest along has been running an 8,323-patient outcomes trial since 2019 and still hasn't reported. So we are now telling every adult to measure a number that, if it comes back high, medicine cannot yet fix.
Measure it anyway. A high Lp(a) changes how hard you go after everything else — apoB, blood pressure, the lot — and it tells your children something true about themselves.
Cautions. One test is meant to last a lifetime and mostly does, though STAR-Lp(a) found 14% of people moved by more than half between readings, so a borderline result is worth repeating. And check the units: mg/dL and nmol/L are not interchangeable, and the conversion between them isn't reliable.
Takeaway. Grade A for prediction. Incomplete for action. Measure it once, around forty, and file it somewhere you'll find it in twenty years.
SPOTLIGHT
⭐ Spotlight: Should You Actually Buy the ApoB Test?
I went into the literature looking for the case that everybody needs one. It isn't there. The case for some people turned out to be stronger than I expected, and I am one of them.
Personal note: I ran the sequence on myself two years ago. Non-HDL was unremarkable. ApoB came back higher than the cholesterol number had any right to suggest. Having spent three pages telling you this is a minority phenomenon, I should say plainly that I'm in the minority. |
Pros. Disagreement between the two numbers is common rather than exotic. In a 5,048-patient analysis, 26.6% of untreated patients had an apoB on target while their LDL cholesterol was raised, or the reverse. At an LDL cholesterol of 100 mg/dL, 95% of people sit somewhere between 66 and 99 mg/dL of apoB.
Two people can walk out with an identical cholesterol result and be carrying a 50% difference in the particles that cause the disease.
Cons. That disagreement isn't randomly sprinkled. It clusters — raised triglycerides, type 2 diabetes, obesity, poor metabolic health, and people already driven to a low LDL cholesterol by a statin. If none of those is you, your apoB will probably repeat what your non-HDL already said, and you'll have paid thirty-odd pounds to hear it twice. The 2026 guideline positions apoB as a refinement once the LDL and non-HDL goals are met. Not as the opening move.
Bottom line: ✅ for raised triglycerides, type 2 diabetes, metabolic syndrome, a family history of early heart disease, or a statin you want to know is finishing the job. ⚠️ for the metabolically healthy and merely curious — the free number first, then decide. |
HYPE CHECK
🚨 Hype Check: The £299 “Ultimate” Blood Panel
The Hype: Medichecks Ultimate Performance at £299, Randox Everyman and Everywoman at around £295, Randox Signature at roughly £599. Sixty, eighty, a hundred markers on a dashboard. The cardiovascular sell inside the expensive tiers is advanced lipoprotein testing: particle number, particle size, small dense LDL.
The Evidence: The 2026 guideline names those techniques and recommends against using them routinely — gradient gel electrophoresis, density gradient ultracentrifugation, NMR spectroscopy, ion mobility analysis. Not “insufficient evidence”. Do not routinely use. It is rare for a guideline to list a commercial product category by method and tell doctors to stop.
Why It's Misleading: Two reasons, and they're independent. First, small dense LDL travels with high triglycerides and low HDL, so knowing it by a fancier method changes nothing anyone does next. Second, the standardisation that lipid panels and apoB enjoy — CDC and WHO-IFCC reference materials, lab-to-lab precision of 6 to 8% — does not extend to particle sizing, so two providers can hand you different answers about the same blood.
Sit with the arithmetic for a second. A hundred markers; about six of them will ever change what you do; and the six are the cheap ones.
Our Verdict: ❌ for the big panel. The evidence-backed version of this purchase is a £39 lipid profile, one apoB if the Spotlight described you, and one Lp(a) you never repeat — sold as a focused cardiovascular panel for £89 to £149. If you're 40 to 74 in England, the NHS Health Check gives you most of it free every five years. |
SUPERFOOD
🥣 Superfood Spotlight: Oats, and an Honestly Small Number
Beta-glucan is a viscous soluble fibre that traps bile acids in the gut, forcing the liver to pull cholesterol out of circulation to replace them. The pooled evidence is unusually large for a food: 58 randomised trials, 3,974 people, a median dose of 3.5 g a day. LDL cholesterol fell 0.19 mmol/L, non-HDL 0.20, and apoB by 0.03 g/L. Those are small numbers and I'd rather say so than dress them up — call it a 5% move. But 3.5 g is about 80 g of porridge oats, and a kilo bag runs to roughly £1.50. Twelve pence a serving. Not a treatment; a rounding error you can eat, applied every morning for thirty years.
BIOHACKING CORNER
🌡 Biohacking Corner: Do One Thing This Week
Find your last blood test and subtract HDL from total cholesterol. That is your non-HDL cholesterol, it costs nothing, and it is the number this entire issue says to start from. Everything below is optional and follows from it.
1. If you don't have a recent panel: £39 privately, or free on the NHS Health Check if you're 40 to 74 in England. Don't fast for it.
2. If the Spotlight described you: add apoB, around £30 as a single marker.
3. If you're over forty and have never had it: add Lp(a), once, and record the units.
4. Then leave it alone. Retest at three months after a real change, not three weeks — lipids drift with illness, alcohol and the season.
Caveat: if you are already on lipid-lowering treatment, do not change anything on the strength of a privately bought result without going back to whoever prescribed it. |
DEEP DIVE
📖 Deep Dive: Your Test Weighs the Cargo. The Damage Is Done by the Lorries.
Everything above tells you which number to get. This one tells you why the field spent forty years measuring the wrong one.
Particles below about 70 nanometres cross into the artery wall freely, and a fraction of them never come back out. Which means the plaque you have at sixty wasn't set by your cholesterol this morning. It was set by how many particles went past, multiplied by how many years they were doing it.
Ference pooled 312,321 people and found that being born with genetically lower LDL cholesterol cut coronary heart disease by 54.5% per mmol/L — roughly three times what a statin started at fifty delivers for the same drop in the same number. Same molecule, same magnitude, triple the effect. The variable doing the work isn't the number. It's the number multiplied by time, which is the one thing no blood test can show you.
👉 Read the Deep Dive: Your Test Weighs the Cargo →
Your Test Weighs the Cargo. The Damage Is Done by the Lorries
One protein per particle, millions of particles, and the reason lifetime exposure beats any number you can measure on a Tuesday morning
Longevity Latest - The Newsletter About The Latest Health Related Science • René Lauritsen
READER PULSE
📊 Reader Pulse
Which of these do you actually know?
• “My non-HDL cholesterol.”
• “My apoB.”
• “My Lp(a).”
• “None of them, and I now feel got at.”
Vote at longevitylatest.com/poll-23. Last week's fitness poll results come back next issue.
CLOSING
🎯 Closing
Three weeks, three systems. Muscle, engine, plumbing — and the plumbing is the one where the number that matters is already sitting in a drawer, unread, costing nothing.
Next week, what to do once you have it. Issue 24 takes on the treatment end: whether a statin earns its place at genuinely low risk, what £4 a month of ezetimibe adds on top, and whether red yeast rice is a natural alternative or an unlabelled dose of the same drug.
Go and do the subtraction.
Stay curious and stay healthy!
— Christian Thomsen, Editor
Longevity Latest is published weekly by FrontWave Media Ltd. The content is for educational purposes and does not constitute medical advice. Cholesterol and lipoprotein results should be interpreted by a clinician alongside your full risk profile. If you are taking lipid-lowering medication, have known cardiovascular disease, familial hypercholesterolaemia, or any diagnosed condition, speak to your doctor before acting on a privately purchased test result, and do not stop prescribed treatment. Consult your physician before starting any new regimen.
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