Boston Heart Cholesterol Balance

All individuals differ when it comes to the balance between cholesterol production and 
absorption. Some people synthesize cholesterol more than they absorb, while others 
absorb more than they synthesize.

Knowing how an individual produces and absorbs cholesterol can help determine the 
most effective LDL-C lowering therapy. Understanding in advance which therapy will 
have the greatest efficacy allows for a more successful and cost-effective CVD 
treatment strategy.

Lathosterol, the direct precursor of cholesterol, can be measured in plasma or serum. 
Eighty percent of synthesized cholesterol goes through lathosterol, while only 20% 
goes through desmosterol. Therefore lathosterol is the only valid marker of cholester
ol production. People who overproduce cholesterol have elevated levels of 
lathosterol normalized to total blood cholesterol levels. Markedly elevated levels of 
lathosterol identify patients with increased risk of premature coronary heart disease.

Plant sterols found in the plasma, beta-sitosterol and campesterol, are direct 
measures of cholesterol absorption. Individuals who over-absorb cholesterol 
in the intestine have elevated levels of these markers. Decreased values, 
which reflect low cholesterol absorption, are optimal. Elevated levels are 
associated with:

• Increased cholesterol absorption and elevated LDL-C levels;
• Increased risk of CVD independent of LDL-C, as shown in both PROCAM 
• (Assmann et al. 2006) and the Framingham Heart Study (Matthan et al. 2009);
• Lack of clinical benefit from simvastatin, as shown in the 4S Study 
• (Miettinen et al. 1998); and,
• Mutation in genes encoding ABCG5 and ABCG8, in patients with marked 
• elevations of plant sterols and premature heart disease.
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