Preval HealthLongevity Genetic Testing
Longevity genetic testing, with a focus on cholesterol.
One optional panel, offered at your first visit. It looks for inherited causes of high LDL cholesterol (LDL-C) such as familial hypercholesterolemia, reads your Lp(a) and APOE genes, checks how you handle statins, and screens metabolic and liver genes. Your licensed clinician reviews the results with you and folds them into your treatment plan.
Always optional. You choose what you want to learn, including whether to see your Alzheimer's genes at all.
Online, nationwide in the US. Protocols written by a board-certified preventive cardiologist.
Why It Matters
What genes add to a cholesterol number
A gene result can explain why your LDL runs high, help your relatives find out whether they share the cause, and support earlier, stronger treatment. Blood tests still guide most cholesterol care, and they should.
It can explain the cause
A very high LDL that doesn't budge with diet often runs in families. A gene change in LDLR, APOB, or PCSK9 confirms familial hypercholesterolemia (FH) and explains why your numbers behave the way they do.
It can protect your family
FH passes from parent to child half the time. Once a gene change turns up in one person, parents, brothers, sisters, and children can be checked for that exact change, a process called cascade testing.
It can shape your plan
A disease-causing FH variant means LDL exposure started at birth, which supports earlier combination treatment. A statin gene result can steer which statin you take and how high the dose goes. Other findings can prompt a liver, iron, or diabetes check.
New to the idea of inherited cholesterol? Start with is high cholesterol genetic? and our familial hypercholesterolemia guide.
What It Looks At
What one panel looks at
Heart and cholesterol genes first, then statin response, metabolic and liver genes, and the results you opt into.
Heart and cholesterol
FH genes, Lp(a), and APOE
- LDLR, APOB, and PCSK9: the main familial hypercholesterolemia (FH) genes. LDLR makes the receptor that pulls LDL out of the blood; changes there cause most FH.
- LPA: the gene behind lipoprotein(a). Gene variants help explain a high Lp(a), and the blood test still sets the number we act on.
- APOE: comes in three common forms, ε2, ε3, and ε4. They nudge LDL up or down, and two copies of ε2 can lead to a rare lipid disorder called dysbetalipoproteinemia, usually when a second factor such as diabetes, extra weight, or low thyroid joins in.
- A coronary polygenic signal (such as the 9p21 region) and rarer lipid genes, including the genes behind very high triglycerides.
Statin response
SLCO1B1 and how you handle statins
- SLCO1B1 makes a transporter that moves statins from the blood into the liver. Reduced-function versions raise statin levels in the blood and the chance of muscle side effects, most clearly with simvastatin.
- Your clinician applies the result using the Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline, which gives statin-by-statin dose guidance.
- The panel also looks at genes tied to statin muscle symptoms, such as COQ2 and HMGCR. Their evidence runs weaker than SLCO1B1, so they add context only.
Metabolic and liver
Diabetes, fatty liver, and iron
- Monogenic diabetes (MODY) genes such as HNF1A, HNF4A, and GCK. A positive result can change which diabetes treatment fits, so it leads to an endocrinology referral.
- Fatty-liver genes PNPLA3 and TM6SF2. Risk variants prompt a liver-scarring check (FIB-4, from routine blood work) and a plan for alcohol and weight.
- HFE, the main iron-overload gene. Two copies of the C282Y variant lead to an iron blood test.
Opt-in and informational
Alzheimer's genes and nutrition genes
- Alzheimer's genes, including APOE ε4 and rare early-onset genes (APP, PSEN1, PSEN2), sit behind a separate opt-in. If you choose to learn them, a genetic counselor delivers the results.
- Nutrition genes (folate, vitamin B12, vitamin D, lactose, caffeine, and others) come back as information. A blood test confirms anything that matters before a plan changes.
- A longevity index sums many common variants into one score. Treat it as context. Your clinician treats your measured numbers.
We go deeper on the statin genes in our statin pharmacogenomics guide. If statins have already given you trouble, see statin intolerance care and what's real about statin side effects.
What a genetic test can't tell you
Your blood numbers still set treatment. Gene tests help, and they're easy to over-read.
- A negative FH gene test doesn't mean your LDL is safe. In a large US study, most people with an LDL-C of 190 or higher had no FH gene found, and they still carried several times the heart risk of people with normal LDL.
- A blood test measures Lp(a) and sets the number that guides decisions. Gene variants only help explain it.
- Gene results don't replace your numbers. LDL, ApoB, and your overall risk still set the target and the treatment.
- A statin gene result adds one piece of information. It doesn't prove a past muscle ache came from the statin, and most people with a variant take statins without trouble.
- Pharmacogenomic evidence runs strongest for simvastatin and SLCO1B1. For other statins the guidance mostly concerns starting dose. The panel leaves out ABCG2 and CYP2C9, two genes that affect rosuvastatin and fluvastatin, so your clinician starts rosuvastatin at 20 mg or less and adjusts from there.
- An APOE ε4 result raises the odds of Alzheimer's disease; it doesn't diagnose it or predict who gets it. Many people with ε4 never develop dementia.
- The panel doesn't test cancer genes. If cancer runs in your family, ask your primary care clinician about cancer genetic testing.
Lp(a) and ApoB are part of advanced lipid testing, the right starting point for most people.
How It Works
From sample to a plan that uses it
Decide at your first visit, send a sample, review the results together, and update your plan. Protocols written by a board-certified preventive cardiologist, care delivered by licensed clinicians through our partner telehealth network.
Offered at your first visit
Your clinician walks through what the panel can find, what it can't, and what it costs, then you decide. If you go ahead, you choose which results you want: heart and metabolic results, and separately, whether to learn your Alzheimer's genes.
Collect a sample
Your clinician orders the test and a kit ships to you. Treatment starts right away without waiting for genetics.
Results visit
About 3 to 4 weeks after the lab gets your sample, your clinician reviews the report with you in plain language, including any variant the lab calls uncertain. A genetic counselor handles Alzheimer's results and any serious non-cholesterol finding.
Your plan updated
A confirmed FH variant can mean an earlier move to combination therapy. A statin gene result can change which statin you take or how high the dose goes. A metabolic, liver, or iron finding leads to the right blood test or referral. Then we keep treating to your LDL and ApoB targets.
One result can inform your whole family
One confirmed FH result lets parents, brothers, sisters, and children be tested for that exact gene change, and each of them has about a 50% chance of carrying it.
FH is autosomal dominant, so one copy of the gene change is enough, and each child of a parent with FH has a 50% chance of inheriting it. Most people with FH remain undiagnosed, so the person who tests first often finds relatives who had no idea.
Once a disease-causing variant is identified, relatives can be tested for that one specific change, which is simpler and more certain than starting from scratch. Children in FH families can have their cholesterol checked as early as age 2.
We review your results with you and talk through which relatives to tell, what to say, and what testing to suggest to them. Their own clinicians can take it from there, and adult relatives are welcome to join our waitlist too.
How it fits with the rest of your care
Longevity genetic testing stays optional, and the rest of your care works the same without it. Preval runs as a cash practice, and care costs $99 a month. Longevity genetic testing costs $499 one time, and your clinician confirms you want it before anything is ordered.
Common questions
Is there a genetic test for high cholesterol?
Yes. A cholesterol genetic test looks for disease-causing changes in the LDLR, APOB, and PCSK9 genes that cause familial hypercholesterolemia (FH), and broader panels add other lipid genes, LPA, and APOE. An expert panel convened by the Family Heart Foundation recommended FH genetic testing for people with definite or probable FH and their at-risk relatives. You don't need a gene test to start treatment, since a very high LDL with a family history is enough.
What does an APOE test show?
Everyone carries two copies of the APOE gene, each one ε2, ε3, or ε4. ε3 is the most common form. ε4 tends to raise LDL a little and raises the chance of Alzheimer's disease, more with two copies than one. ε2 tends to lower LDL, and two copies of ε2 can lead to a rare lipid disorder called dysbetalipoproteinemia, usually alongside a second factor. Expert genetics groups advise against using APOE to predict Alzheimer's in people without symptoms, so we keep the Alzheimer's part behind a separate opt-in, with a genetic counselor delivering the result.
Do I have to learn my Alzheimer's risk?
No. You choose at your first visit. The Alzheimer's genes sit behind a separate opt-in, and only a genetic counselor shares those results. One caveat: APOE also affects cholesterol, so your APOE type appears in the cholesterol section of the report. Your clinician explains this before you consent.
What is genetic testing for medication?
Pharmacogenomic testing looks at genes that change how your body absorbs, moves, or clears a medicine. For statins, the best-studied gene is SLCO1B1, and the panel includes it. Two other statin genes, ABCG2 (rosuvastatin) and CYP2C9 (fluvastatin), sit outside this panel. The CPIC guideline translates each result into a statin choice and starting dose.
Is genetic testing included with Preval?
It's optional. Your clinician offers longevity genetic testing at your first visit. It costs $499 one time, and nothing is ordered until you say yes. Preval runs as a cash practice and doesn't bill insurance. The rest of your care works the same whether or not you test.
If my FH gene test is negative, can I relax about my cholesterol?
Unfortunately not. Many people with very high LDL have no single FH gene found, often because many small variants add up instead. Their heart risk stays high, and treatment follows the LDL number and overall risk either way.
Should I stop my statin if I have an SLCO1B1 variant?
No. The CPIC guideline says statins should not be stopped or avoided because of a gene result when you need one. The usual change is to switch away from simvastatin or adjust the dose of another statin. If you've taken a statin for a while without problems, staying on it often makes sense.
Can genetic test results affect my insurance?
In the US, the Genetic Information Nondiscrimination Act (GINA) stops health insurers and most employers from using genetic results against you. It does not cover life, disability, or long-term care insurance, so those insurers may be able to ask about genetic results, depending on your state. Weigh that before you test. We talk it through with you at your first visit.
Should my family get tested?
If a disease-causing FH variant turns up, each first-degree relative (parents, siblings, children) has about a 50% chance of carrying it. They can be tested for that specific change, and at minimum they should get a cholesterol panel. We review your results with you and talk through how to bring it up with family.
Learn why your cholesterol runs high.
We're rolling out care slowly and taking a limited number of patients. Join the waitlist to get an early spot.
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