Protocols
A rational, budget-tiered testing schedule for a healthy, asymptomatic adult, built directly from the grades on this site rather than from what's easiest to bundle and sell. Higher tiers add tests as evidence and cost both increase — they do not simply add more tests indiscriminately. This is a template for a conversation with your own doctor, not a prescription.
Basic
Foundational, guideline-backed screening appropriate for most healthy adults. Everything here is graded Strong.
Frequency: most components every 1–3 years once a baseline is established (see individual test pages); annually if you have metabolic risk factors or are on relevant medication.
Intermediate
Everything in Basic, plus risk-stratification tests with Moderate-to-Strong evidence, several of which are once-in-a-lifetime or targeted rather than annual.
- Apolipoprotein B (ApoB) — evidence card
- Lipoprotein(a) — once, lifetime · evidence card
- hs-CRP — once, if intermediate cardiovascular risk · evidence card
- Ferritin — if symptomatic or at-risk, not routine · evidence card
- Thyroid function — if symptomatic or risk factors
- Vitamin B12/folate — if in an at-risk group
- Testosterone — men, if symptomatic
- DEXA (bone density) — per age/risk guideline
Add tests here based on individual risk factors, not by default — see each test's "appropriate for" note.
Advanced
Higher-cost, indication-based imaging. Not annual, not for everyone — appropriate mainly from the 40s onward, or with specific risk factors, in consultation with a doctor.
- Coronary Artery Calcium (CAC) score — once, around age 40–50, if intermediate cardiovascular risk (is it worth it? full breakdown)
- Cardiac CT/MRI — only if CAC is abnormal, or symptomatic
- DEXA body composition — optional, for tracking a specific fitness/fat-loss goal
- APOE genotype — only with genetic counselling and a specific clinical indication (see Emerging & Overhyped)
Notably absent: carotid ultrasound, routine abdominal/brain MRI, gut microbiome testing, epigenetic clocks. See below for why.
Deliberately excluded from every tier
These tests appear frequently in premium executive-health packages but are graded Weak or Emerging on this site and are not part of any tier above, regardless of budget. See the Scans and Emerging & Overhyped pages for the full evidence discussion of each.
| Test | Grade | Why it's excluded from routine screening |
|---|---|---|
| Carotid ultrasound | Weak | USPSTF explicitly recommends against screening asymptomatic adults |
| Abdominal MRI (general screen) | Weak | No validated screening pathway; high incidental-finding rate |
| Brain MRI (general screen) | Weak | No validated screening pathway; high incidental-finding rate |
| Gut microbiome testing | Weak | No regulatory-approved clinical use; poor inter-provider reliability |
| Epigenetic clocks | Emerging | Not validated for individual-level decisions per current literature |
| Fasting insulin / HOMA-IR (routine) | Weak | Poor assay standardisation; no proven added value over HbA1c/glucose for screening |
| Homocysteine | Weak | Lowering it does not reduce cardiovascular events (HOPE-2) |
| Uric acid (routine) | Weak | Not causally validated as an independent cardiovascular/longevity marker |
| GGT (standalone) | Weak | Non-specific beyond its role in a standard liver panel |
| Vitamin D (routine) | Weak | USPSTF twice found insufficient evidence to screen asymptomatic adults; VITAL trial found supplementation doesn't cut cancer or CVD risk |
How to use this page
- Start with Basic — it covers the highest-value, cheapest, best-evidenced tests for almost everyone.
- Move to Intermediate selectively, based on your actual risk factors (family history, symptoms, metabolic risk) — not as a default upgrade.
- Only consider Advanced imaging from your 40s, or earlier with specific risk factors, and ideally after discussing your calculated cardiovascular risk with a doctor.
- If a clinic offers you a bundled package, ask which specific components are Strong/Moderate for you, and consider declining the Weak/Emerging components rather than paying a flat price for all of them — see real 2026 executive package pricing compared across 3 Singapore providers (S$398–S$12,888) before assuming a higher tier is a better buy.
Not sure which tier fits your situation? The suitability check asks four factual questions (age band, risk factors, symptoms, current spending) and points at the tier those answers correspond to — a shortcut through this page, nothing more.