The addition of the metabolomic state to the comprehensive PANEL predictors led to further improvements in the utility for reasonable ranges of decision thresholds for 11 of the 24 endpoints (most notably T2D, heart failure and, to a lesser extent, dementia; see Supplementary Fig. 1 for details on all endpoints and Extended Data Fig. 7 for additional analyses investigating apolipoprotein 4 (APOE4) carrier status for dementia). Here, APOE is linked to heart failure.