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  • Test Details
  • Lab Values
  • Clinical Significance
  • Treatment Options
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Test Code 509

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.

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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

None

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

Overview
Lab Values

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

  • Optimal: <0.5
  • Borderline: 0.5-1.1
  • High: >1.1
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