Overview
Boston Heart Cholesterol Balance ® Test
Abnormalities in cholesterol metabolism have been associated with patient response to statin and ezetimibe therapy for LDL cholesterol (LDL-C) lowering.
Boston Heart’s exclusive Cholesterol Balance test directly measures the major production markers (lathosterol and desmosterol) and absorption markers (beta-sitosterol, campesterol and cholestanol) for circulating plasma cholesterol. The levels of these markers are indicators of LDL-C lowering response to treatments (e.g., statins or ezetimibe). This information enables healthcare providers to prescribe the most effective treatment strategy to lower LDL-C and help patients achieve their LDL-C goal.
Test Details
Boston Heart Cholesterol Balance ® Test
Boston Heart Diagnostics Cholesterol Balance® test measures markers of cholesterol production (lathosterol and desmosterol) and absorption (beta-sitosterol, campesterol, and cholestanol)
Methodology
Lipid extraction followed by capillary column gas liquid chromatography and mass spectrometry (GC/MS)
Patient Preparation
8 hour fast prior to collection. Patient may drink water, black coffee or tea (no dairy or sugar).
Preferred Specimen
1.0 mL serum (0.5 mL minimum) collected in serum separator tube (SST/Tiger Top)
Alternative Specimen
1.0 mL EDTA plasma (0.5 mL minimum) collected in plasma separator tube (Pearl Top)
Transport Temperature
Refrigerated (ship on frozen cold packs)
Stability
Refrigerated: 5 days
Lab Values
Boston Heart Cholesterol Balance ® Test
Lathosterol
Marker of cholesterol production
- Optimal: <85 μmol/mmol of total cholesterol (TC)
- Borderline: 85-125 μmol/mmol of TC
- High: >125 μmol/mmol of TC
- Alert: >7.0 mg/L (absolute value)
Desmosterol
Marker of cholesterol production
- Optimal: <65 μmol/mmol of TC
- Borderline: 65-75 μmol/mmol of TC
- High: >75 μmol/mmol of TC
- Alert: >5.0 mg/L (absolute value)
Beta-sitosterol
Marker of cholesterol absorption
- Optimal: <115 μmol/mmol of TC
- Borderline: 115-155 μmol/mmol of TC
- High: >155 μmol/mmol of TC
- Alert: >7.0 mg/L (absolute value)
Campesterol
Marker of cholesterol absorption
- Optimal: <170 μmol/mmol of TC
- Borderline: 170-230 μmol/mmol of TC
- High: >230 μmol/mmol of TC
- Alert: >10.0 mg/L (absolute value)
Cholestanol
Marker of cholesterol absorption
- Very high absolute value: >15.0 mg/L
Cholesterol Balance Score
Production/Absorption
- Over Absorber: <0.5
- Balanced: 0.5-1.1
- Over Producer: >1.1
Clinical Significance
Boston Heart Cholesterol Balance ® Test
High lathosterol and desmosterol indicate cholesterol overproduction1
- Associated with higher LDL-C and increased CVD risk
- Associated with familial combined hyperlipidemia2
High campesterol and beta-sitosterol indicate cholesterol overabsorption
- Associated with higher LDL-C and increased CVD risk
- May be associated with tendon xanthomas, premature CVD and phytosterolemia if values are very high3
High absolute value of cholestanol indicates decreased conversion of cholesterol to the bile acid chenodeoxycholate4
- May be associated with tendon xanthomas, neurologic disease and cerebrotendinous xanthomatosis if values are very high
References:
- Matthan NR, Resteghini N, Robertson M, et al. Cholesterol absorption and synthesis markers in individuals with and without a CHD event during pravastatin therapy: Insights from the PROSPER trial. J Lipid Res. 2010;51(1):202–209.
- Van Himbergen TM, Otokozawa S, Matthan NR, et al. Familial combined hyperlipidemia is associated with alterations in the cholesterol synthesis pathway. Arterioscler Thromb Vasc Biol. 2010;30(1):113–120.
- Patel MD, Thompson PD. Phytosterols and vascular disease. Atherosclerosis. 2006;186(1):12–19.
- Björkhem I, Leoni V, Meaney S. Genetic connections between neurological disorders and cholesterol metabolism. J Lipid Res. 2010;51(9):2489–2503.
Treatment Options
Boston Heart Cholesterol Balance ® Test
Initiate appropriate treatment after correcting contributing causes for elevated LDL-C
- Lifestyle modification (if indicated)
- Overproducer—Consider statin. If statin is indicated, or if dosage is being increased, consider testing patient for SLCO1B1 before prescribing
- Overabsorber— Consider adding soluble fiber
- Statin with ezetimibe may be used together for additional LDL-C lowering
