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
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
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
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
