The Boston Heart Cholesterol Balance test measures production and absorption markers in blood samples. This can help determine treatment for lowering low-density lipoprotein (LDL) cholesterol.

By providing a thorough assessment of cholesterol metabolism, the Boston Heart Cholesterol Balance test can help evaluate how effective treatments such as statins and ezetimibe will be in lowering LDL cholesterol.

Some people refer to LDL cholesterol as “bad” cholesterol. Lowering LDL cholesterol can help decrease the risk of conditions such as stroke and heart attack.

Read on to learn more about the role of the Boston Heart Cholesterol Balance test, when doctors might recommend it, and more.

The Boston Heart Cholesterol Balance test measures production markers called lathosterol and desmosterol and absorption markers called beta-sitosterol, campesterol, and cholestanol.

For people with elevated cardiovascular risk who require lipid-lowering therapy, Boston Heart suggests that doctors may recommend tailored treatments based on the levels of these markers. Levels of these markers can be optimal, borderline, or high.

The following provides examples of how test results can shape treatments:

  • If levels show that production markers are high, doctors may recommend statins.
  • If absorption markers are high, ezetimibe may help.
  • If both production and absorption markers are high, doctors may recommend statins.
  • Doctors can also prescribe a combination of statins and ezetimibe to target both production and absorption.

The Boston Heart Cholesterol Balance test always represents marker values as micromole (µmol) x 100/millimole (mmol) of total cholesterol. A medical professional can provide information about what the marker values mean in relation to your test results.

According to Boston Heart Diagnostics, optimal production and absorption markers are as follows:

  • <85 μmol/mmol of total cholesterol (TC) for lathosterol
  • <65 μmol/mmol of TC for desmosterol
  • <115 μmol/mmol of TC for beta-sitosterol
  • <170 μmol/mmol of TC for campesterol

High production and absorption markers include:

  • >125 μmol/mmol of TC for lathosterol
  • >75 μmol/mmol of TC for desmosterol
  • >155 μmol/mmol of TC for beta-sitosterol
  • >230 μmol/mmol of TC for campesterol

Boston Heart doesn’t provide a normal range for cholestanol, but reports if cholestanol has a very high absolute value of >15.0 mg/L.

The Boston Heart Cholesterol Balance is a blood test. A medical professional will take a blood sample and send it off to the laboratory for analysis.

You will usually need to fast for 8 hours before the test. This means not eating anything, and drinking only water, black coffee, or tea without any sugar or dairy.

Major professional society guidelines do not recommend routinely measuring biomarkers of cholesterol absorption or production, likely because there is not much data on how helpful it is to tailor treatment using this strategy.

However, Boston Heart Diagnostics explains that the test provides a more complete overview of the risks of cardiovascular disease compared with standard lipid testing.

The test may be particularly useful to diagnose a suspected genetic problem related to cholesterol production or absorption. For example, the test can uncover very high levels of cholestanol, which is present in a rare condition called cerebrotendinous xanthomatosis.

Various factors can cause high LDL cholesterol levels. They include lifestyle habits, medical conditions, and some medications.

Lifestyle habits

Lifestyle habits that can increase the risk of high LDL cholesterol include include:

  • consuming a diet high in saturated fats
  • not getting enough physical activity or exercise
  • cigarette smoking
  • drinking a lot of alcohol
  • stress

Doctors will also advise on managing these risk factors through lifestyle changes. You may also require medication to manage cholesterol levels.

Medical conditions

Having a family history of high cholesterol or having certain health conditions can make high LDL cholesterol more likely. Some of these conditions include:

Treating these conditions may help with managing LDL cholesterol.

Medications

Medications that may increase LDL cholesterol levels include:

  • beta-blockers
  • diuretics
  • arrhythmia medications
  • retinoids
  • steroids
  • chemotherapy medications

Speak with your doctor if you have concerns about any medication you are currently taking. It is important to continue taking any prescription medication until a doctor advises otherwise.

The Boston Heart Cholesterol Balance test is a blood test that can provide more detail about low-density lipoprotein (LDL) cholesterol levels. The test measures production and absorption markers, including lathosterol, desmosterol, beta-sitosterol, campesterol, and cholestanol.

While guidelines don’t recommend this test for everyone, for some people it can help diagnose rare genetic problems related to cholesterol storage. The test may help doctors tailor treatment to target cholesterol absorption, cholesterol production, or both

The Boston Heart Cholesterol Balance test helps suggest which treatments may be the most effective. For example, doctors may recommend statins if production markers are high and absorption markers are borderline. For borderline production markers and high absorption markers, they may recommend a combination of statins and ezetimibe.

It is usually necessary to fast for 8 hours before the blood test. Your doctor will be able to interpret the test results and provide information about the levels mean. They can then help you create a suitable treatment plan and advise on ways to manage LDL cholesterol levels.