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  • Overview
  • Test Details
  • Lab Values
  • Clinical Significance
  • Treatment Options

Explore this test

Test Code 501

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

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

8-12 hour fast prior to collection. Patient may drink water only.

Preferred Specimen

1.0 mL EDTA plasma (0.5 mL minimum) collected in plasma separator tube (Pearl Top)

Alternative Specimen

1.0 mL serum (0.5 mL minimum) collected in serum separator tube (SST/Tiger Top)

Transport Temperature

Refrigerated (ship on frozen cold packs)

Stability

Refrigerated: 5 days

Overview
Lab Values

Lab Values

Boston Heart Cholesterol Balance® Test

Lathosterol

Marker of cholesterol production

  • Optimal: <90 μmol/mmol of total cholesterol (TC)
  • Borderline: 90–160 μmol/mmol of TC
  • High: >160 μmol/mmol of TC
  • Alert: >7.0 mg/L (absolute value)

Desmosterol

Marker of cholesterol production

  • Optimal: <70 μmol/mmol of TC
  • Borderline: 70–90 μmol/mmol of TC
  • High: >90 μmol/mmol of TC
  • Alert: >5.0 mg/L (absolute value)

Beta-sitosterol

Marker of cholesterol absorption

  • Optimal: <100 μmol/mmol of TC
  • Borderline: 100–180 μmol/mmol of TC
  • High: >180 μmol/mmol of TC
  • Alert: >7.0 mg/L (absolute value)

Campesterol

Marker of cholesterol absorption

  • Optimal: <150 μmol/mmol of TC
  • Borderline: 150–260 μmol/mmol of TC
  • High: >260 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

  • Very low: 0.2
  • Low: <0.5
  • Normal: 0.5-1.1
  • High: >1.1
  • Very high: >2.1
Test Details
Clinical Significance

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:

  1. 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.
  2. 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.
  3. Patel MD, Thompson PD. Phytosterols and vascular disease. Atherosclerosis. 2006;186(1):12–19.
  4. Björkhem I, Leoni V, Meaney S. Genetic connections between neurological disorders and cholesterol metabolism. J Lipid Res. 2010;51(9):2489–2503.
Lab Values
Treatment Options

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

 

Clinical Significance