The relationship between skin cholesterol testing and parameters of cardiovascular risk: a systematic review

A potential correlation between skin cholesterol levels obtained via skin biopsy and evidence of underlying atherosclerosis has been reported. With the availability of a noninvasive method of skin cholesterol measurement, multiple studies investigated the association of skin cholesterol and traditional cardiovascular risk factors. We provide a systematic review of clinical data to assist physicians counselling patients that have undergone skin cholesterol testing and to provide a framework for future research.

Multiple electronic databases were systematically searched for studies published from 1970 through February 2013. Selection criteria included English language, peer-reviewed studies that quantitatively examined the relationship between noninvasively measured skin cholesterol levels and indices of vascular disease or cardiovascular risk factors in human subjects.

We identified 9 cohorts reported in 11 studies. The studies suggest that skin cholesterol does not correlate with traditional markers of cardiovascular disease such as serum lipid values and inflammatory markers, and integrated risk scores (Framingham and Prospective Cardiovascular Münster [PROCAM]). Single studies reported a significant relationship between skin cholesterol levels and evidence of underlying atherosclerosis as implied by positive exercise testing, invasive coronary angiography, increased calcium scores in Caucasian patients, and presence of carotid plaque detected using B-mode ultrasound. Two studies identified a significant relationship using B-mode measurements of carotid intima medial thickening.

Skin cholesterol might be a marker of underlying vascular atherosclerosis. Further prospective investigations are warranted to establish utility of this point-of-care test for identifying subjects warranting formal cardiovascular risk assessment.