Preventative Health Panel at 40
The 40s are the decade where “assume I’m healthy” gives way to “actually look under the hood.” Almost everything that becomes life-threatening at 65 has a measurable trendline at 40. Catching the trend early is much cheaper and easier than treating the disease later.
This page covers the specific tests worth running annually, with rationale for each and reference ranges to expect.
For a lean ultra-runner, several specific markers commonly come back unexpectedly off — high hsCRP, low vitamin D, low free T3, sometimes high homocysteine. Knowing the dashboard makes it interpretable rather than alarming.
The annual blood panel
Get these all in a single fasting blood draw, ideally first thing in the morning.
Cardiovascular markers
Lp(a) — once in a lifetime
- The single most under-ordered cardiovascular test
- Genetically determined, doesn’t change with lifestyle
- ~20% of people have elevated Lp(a), which roughly doubles heart-attack risk
- Test result is the same at 40 as it will be at 70
- Reference: < 75 nmol/L (or < 30 mg/dL) is normal; > 125 nmol/L (or > 50 mg/dL) is elevated
- If elevated, it changes the rest of the cardiovascular game plan — more aggressive ApoB management
ApoB (Apolipoprotein B) — annually
- Better predictor of heart-attack risk than LDL-C
- Reflects the number of atherogenic particles, not their cholesterol content
- Reference for low cardiovascular risk: < 80 mg/dL
- Optimal for high-risk: < 60 mg/dL
Standard lipid panel — annually
- Total cholesterol, LDL, HDL, triglycerides
- Less important than ApoB but cheap and commonly run together
Metabolic markers
Fasting insulin — annually, often missed
- In lean people, fasting glucose can look normal for years while insulin slowly rises
- The TOFI (Thin Outside, Fat Inside) phenotype is real — low BMI doesn’t exclude visceral fat or insulin resistance
- Reference: < 6 μIU/mL is optimal; 6–10 is borderline; > 10 suggests insulin resistance
- More informative than HbA1c at the early stages
HbA1c — annually
- 3-month average glucose
- Reference: < 5.4% optimal; 5.5–5.6% is “watch this”; > 5.7% is pre-diabetes
- A lean active person above 5.4% is a signal worth investigating (often dietary timing or stress, not pure overeating)
Fasting glucose — annually
- Reference: < 90 mg/dL ideal; 90–99 acceptable; 100–125 pre-diabetes
Inflammation
hsCRP (high-sensitivity C-reactive protein) — annually
- Systemic inflammation marker
- Ultra-runners often run chronically elevated (~2–5 mg/L) — the body is repairing micro-damage
- Reference: < 1 mg/L is low cardiovascular risk; 1–3 is moderate; > 3 is high
- Take fresh after a rest day, not the day after a long run, to get a baseline reading not skewed by acute exercise inflammation
- Persistently > 3 in a lean active person is unusual and worth investigating (oral microbiome, gut, undiagnosed condition)
Nutritional / hormonal
25(OH) Vitamin D — annually
- Korean winters + sunscreen-using lifestyle in India = likely deficiency
- Reference: 50–80 ng/mL is the longevity sweet spot; < 30 is deficient
- If low, supplement 2000–4000 IU D3 daily (see Supplement Stack for Endurance Athletes Past 40)
Vitamin B12 — annually
- Endurance athletes deplete via heavy turnover
- Reference: > 500 pg/mL ideal (the “normal” lab range bottoming at 200 is too low)
- If low, methylcobalamin or hydroxocobalamin oral supplement; or B12 injection from a clinic
Ferritin — annually
- Iron stores; endurance athletes deplete from heavy training and sweat loss
- Reference: 40–150 ng/mL for active men; < 30 means start supplementing
- Indian-genetic anaemia risk is higher than European average
TSH, free T3, free T4 — annually
- Thyroid function
- Endurance athletes commonly run subclinical low T3 (the active thyroid hormone) — body downregulating to conserve energy
- Reference TSH: 0.4–2.5 mIU/L optimal (lab range goes up to 4.5 but anything above 2.5 is suboptimal)
- Reference free T3: at the upper third of the lab range
Homocysteine — annually
- Cardiovascular and cognitive risk marker
- Elevated when B vitamins (especially B12 and folate) are low
- Reference: < 8 µmol/L is optimal; > 10 is elevated
Hormones
Testosterone (total + free), SHBG — annually
- Naturally declines ~1% per year after 30
- Endurance training plus low body fat suppresses further
- Reference total T for 40s: 500–800 ng/dL; below 400 is low even at 40
- Reference free T: at the upper third of lab range
- See Less-Discussed Health Checks at 40 for full hormone discussion
Cortisol (morning, fasted)
- Chronic stress marker
- Reference: 6–18 µg/dL between 7–9 AM; persistently above 20 is a stress signal
DHEA-S, oestradiol — useful supporting hormonal context; less critical annually
Other useful adds
- CBC (complete blood count) — covers anaemia, infection, immune signal
- Liver function (ALT, AST, GGT) — should be unremarkable; flags occult issues
- Kidney function (creatinine, eGFR, BUN) — endurance athletes often show slightly elevated creatinine due to muscle mass; cross-check with cystatin C if creatinine looks weird
- Uric acid — elevated in some lean people, drives gout risk
- Magnesium RBC — not just serum magnesium (which is held constant). RBC magnesium reveals tissue status
Imaging
DEXA scan — once at 40, then every 2 years
The single most important scan for this phenotype.
- Measures bone density at hip and spine — see Bone Density for Lean Runners
- Also reports lean muscle mass and body fat distribution
- Expect to find osteopenia at the femoral neck if you’re a lifelong runner
- Cost in Seoul / tier-1 Indian cities: USD 50–150
Coronary calcium score — once at 40
- Low-radiation CT that measures calcified plaque in coronary arteries
- A reading of 0 at 40 is reassuring for the next 5–10 years
- A non-zero reading flips the cardiovascular risk picture and intensifies the ApoB target
Whole-body MRI — every 2–3 years (optional but useful)
- No radiation
- Catches asymptomatic cancers, aneurysms, kidney issues
- Controversial because of incidental findings (causing follow-up scans, anxiety, sometimes unnecessary biopsies)
- For an analytical personality who handles false positives without panic, the asymmetry is worth it
- Cost: USD 1,500–3,000 at Prenuvo, Ezra, or equivalent
Skin check by a dermatologist — annually
- Two decades of outdoor running mean accumulated UV exposure
- Indian skin tone reduces melanoma risk but doesn’t eliminate it
- Basal and squamous cell carcinomas affect all skin tones
- Cost: USD 50–150 in most countries
Colonoscopy — at 45, then every 5–10 years
- Standard guidance moved from 50 to 45 because of rising colon cancer rates in younger adults
- Earlier if any family history
Eye exam with OCT — every 2 years from 40
- OCT (optical coherence tomography) catches glaucoma and macular degeneration early
- Also reveals signs of diabetes and hypertension via retinal microvasculature
- Cost: USD 60–150
What this costs annually
Rough budget for the dashboard, paid out of pocket:
| Item | Cost (USD) | Frequency |
|---|---|---|
| Comprehensive blood panel | 150–400 | Annual |
| DEXA scan | 50–150 | Every 2 years |
| Coronary calcium score | 100–250 | Once at 40 |
| Whole-body MRI | 1,500–3,000 | Every 2–3 years |
| Skin check | 50–150 | Annual |
| Eye exam with OCT | 60–150 | Every 2 years |
| Audiogram baseline | 30–80 | Once at 40 |
A typical year hits around USD 500–1,500. The MRI year doubles that. For someone earning a senior-finance salary, this is genuinely the highest-leverage discretionary spending available.
How to use the data
Don’t optimise every single marker. The point is the trend over time.
- Take the blood panel at the same time of year, same lab if possible
- Track results in a spreadsheet (or a Notion / Obsidian table)
- Flag anything that moves > 15% year over year
- Don’t panic at a single bad reading — wait for confirmation or retest in 2–4 weeks
The analytical-personality risk is over-tweaking based on noise. Trends matter; single data points don’t.
What the doctor probably won’t order without asking
In most countries, a standard “annual physical” covers maybe half the panel above. The other half (Lp(a), fasting insulin, hsCRP, free T3, ApoB, homocysteine) usually has to be specifically requested.
A reasonable script:
“I’m 40 and trying to set a comprehensive health baseline. Can we run a fasting panel that includes Lp(a) (one-time), ApoB, fasting insulin, hsCRP, vitamin D, ferritin, B12, TSH with free T3 and free T4, homocysteine, and total/free testosterone in addition to the standard CBC and metabolic panel?”
Most clinicians will order these on request without resistance. Private clinics and labs in Seoul and major Indian cities are particularly accommodating.