GrimAge

GrimAge is a second-generation epigenetic clock introduced by Lu et al. (2019, with Steve Horvath as senior author). Instead of predicting chronological age, it is trained on time-to-death and combines DNA-methylation surrogates for seven plasma proteins (e.g. PAI-1, GDF-15) and DNAm-based smoking pack-years. In multiple cohorts GrimAge and the updated GrimAge2 (2022) outperform earlier clocks at predicting all-cause mortality, cardiovascular disease and cancer. It is widely used in research; clinical use as a diagnostic endpoint remains investigational.