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Cholesterol Functional Testing

A revolutionary, non-invasive process that can identify patients at higher risk for developing cardiovascular disease or stroke.

Over the past century, biologists have portrayed the skin as a simple protective coating for the more complex and internal organs. Over the past few decades, accumulated research has revealed the skin to the largest and one of the more complex organs of the human body. Recent research has revealed that the skin is also directly involved in cholesterol metabolism. Cholesterol sterol synthesis in the skin accounts for approximately 30% of total body sterol synthesis. Furthermore studies have shown that cholesterol in the skin can be considered a “mirror” of atherosclerosis of the aorta. Given the accessibility of cholesterol in the skin and its correlation to atherosclerotic disease, a non-invasive and accurate chemical test to estimate epidermal cholesterol has been developed. The test could play an important role in assessing patients for potential risk before symptoms occur.


  • Cardiovascular disease is the number 1 killer in North America
  • 50% of those die suddenly from CAD did not experience major prior symptoms
  • 8 of 10 North Americans have at least 1 risk factor for CAD
  • ½ of all first time events are not diagnosed with today’s standard blood tests
  • 50% of those who have an event have normal LDL cholesterol levels

Measuring Skin Cholesterol

Skin contains 11% of all cholesterol in the body. The main source of skin sterol (skin tissue cholesterol) are epithelial steroidogenesis and cholesterol diffusion from circulation via LDL and SR-B1 receptors. Cholesterol in the blood circulates in the vessels and varies depending on food consumption. Skin sterol is cholesterol that is deposited in the tissues over time.

Measuring the content of cholesterol in skin tissue is a noninvasive way to assess the thickness of the carotid artery wall. The test is designed to measure the actual cholesterol deposition in tissues, compared to the amount of serum cholesterol in the blood. The skin sterol test involves applying a special solution to a small area of the palm for one minute. The area is then blotted dry and an indicator solution applied, which turns blue. The hue depends on the cholesterol level, and can be accurately measured with a probe connected to a computer.

Note: to minimize the confusion between skin cholesterol and serum (blood) cholesterol measurements, the former is referred to as skin sterol or skin tissue cholesterol

Important Benefits

  • non-invasive – no blood sample is required
  • does not require fasting
  • simple and easy to use
  • results take 5 minutes
  • provides additional information for risk assessment
  • provides long-term view of cholesterol accumulation and tissue burden

Published Studies

Mancini J et al. Association of skin sterol measured by a non-invasive method, with markers of inflammation and Framingham risk prediction. American Journal of Cardiology 2002; 89:1313-16.

Ouyang P et al. Skin tissue cholesterol assay correlated with presence of coronary calcium. Atherosclerosis 2005; 181:167-173.

Sprecher DT et al. Skin tissue cholesterol is related to aniographically-defined cardiovascular disease. Atherosclerosis 2003; 171:255-258.
Sprecher DT et al. Skin tissue cholesterol assay correlates to myocardial infarction Atherosclerosis 2005; 181:371-373.

Zawydiwski R et al. Technical Briefs – specificity; skin tissue cholesterol related to stress test. Clinical Chemistry 2001; 47 No. 7:1302-1304.