97: Buck’s Boston Heart Cholesterol Balance Test

Aug 19, 2024 · 21m 41s

Description

Link to Buck's Results: https://drive.google.com/file/d/19BJaZNYwBxlPx4nR9695Q2NC3nNpgW6y/view?usp=sharing https://drive.google.com/file/d/1br1ikAJKmgKev9X3jkS7nUPdXpAqMzYd/view?usp=sharing Section 1: Overview of Cholesterol Metabolism - Cholesterol in the Body: - Cholesterol is essential for cell membrane integrity, hormone synthesis, and bile acid...

Cholesterol in the Body:
- Cholesterol is essential for cell membrane integrity, hormone synthesis, and bile acid production.
- It is produced endogenously in the liver and absorbed exogenously from dietary sources.
Endogenous Production:
- Cholesterol is synthesized in the liver through the mevalonate pathway.
- Key intermediates: Lathosterol and Desmosterol, indicators of cholesterol production rate.
Exogenous Absorption:
- Dietary cholesterol is absorbed in the intestines along with plant sterols like Beta-sitosterol and Campesterol.
- These sterols compete with cholesterol for absorption, reflecting dietary cholesterol absorption levels.

Section 2: Detailed Analysis of the Test Components

Production Markers:
- Lathosterol:
  - Precursor in the cholesterol biosynthesis pathway.
  - Elevated levels indicate increased hepatic cholesterol synthesis (overproduction).
  - Example: Lathosterol level of 329 µmol x 100/mmol in my study indicates hyperactive cholesterol production.
- Desmosterol:
  - Another precursor in the synthesis pathway, contributing to total cholesterol production.
  - High levels reinforce the diagnosis of increased cholesterol production.
  - Example: Desmosterol level of 74 µmol x 100/mmol in my study supports elevated production.
Absorption Markers:
- Beta-sitosterol:
  - Plant sterol absorbed in the intestines, competes with cholesterol.
  - High levels suggest increased absorption of dietary cholesterol.
  - Example: Beta-sitosterol level of 120 µmol x 100/mmol indicates borderline absorption.
- Campesterol:
  - Similar to Beta-sitosterol, reflects cholesterol absorption efficiency.
  - Elevated levels indicate increased absorption.
  - Example: Campesterol level of 113 µmol x 100/mmol within normal limits but suggests absorption could be a factor.
Cholesterol Balance Score:
- Ratio of production to absorption markers.
- A higher score indicates predominant cholesterol production; a lower score indicates absorption as the main issue.
- Example: Score of 2.4 suggests overproduction is the dominant issue.

Section 3: Clinical Implications and Treatment Strategies (10 minutes)

Frequency of Overproduction vs. Overabsorption:
- Common to see patients with either overproduction or overabsorption, but less commonly both.
- Overproducers: Significant portion of hypercholesterolemia patients, especially those with genetic conditions like Familial Hypercholesterolemia.
- Overabsorbers: Often have high-cholesterol diets or genetic predispositions.
Treatment Implications:
- Overproducers: Statins are first-line treatment; they inhibit HMG-CoA reductase in cholesterol synthesis.
- Overabsorbers: Ezetimibe, which inhibits intestinal cholesterol absorption, can be effective.
- Combination Therapy: Considered for mixed dyslipidemia cases.
Case Examples:
- Example of a patient with high production markers but borderline absorption: Statin therapy may be appropriate, with potential addition of Ezetimibe.
- Example of a patient who is a high absorber but not a high producer: Dietary changes and Ezetimibe might suffice without statins.

Section 4: Physiological Mechanisms and Genetic Considerations

Pathophysiology of Cholesterol Production:
- Overproduction may result from genetic mutations (LDL receptor or PCSK9) or conditions like insulin resistance.
Pathophysiology of Cholesterol Absorption:
- Increased absorption could be due to genetic polymorphisms (NPC1L1 gene), leading to higher dietary cholesterol absorption.

Section 5: Practical Application in Clinical Practice

Incorporating the Test into Clinical Workflow:
- Integrate the Boston Heart Cholesterol Balance Test for patients with unexplained hypercholesterolemia or non-responders to standard therapy.
- Tailor treatment based on whether a patient is an overproducer, an overabsorber, or both.
Patient Communication:
- Explain test results in an understandable way, emphasizing personalized treatment plans.

show less

Comments

Information

Author	Buck Joffrey
Organization	Richard bonn
Website	-
Tags	#absorber #apob #cardiovascularhealth #cholesterolmetabolism #cholesterolmonitoring #geneticfactors #keywordsbostonheartcholesterol #producer #treatmentstrategies