The rationale for lowering serum cholesterol levels in American children

* The pediatric approach to the primary prevention of coronary artery disease in adults remains controversial. Measurement and intervention to lower serum cholesterol levels have been advocated recently in a selected group of American children by the Expert Panel on Blood Cholesterol Levels in Children and Adolescents of the National Cholesterol Education Program. This article reviews the clinical and scientific data contributing to the controversy surrounding cholesterol in American children. Arguments in favor of and opposed to an aggressive approach to identifying American children with elevated serum cholesterol levels are presented. The rationale for a selective screening approach is demonstrated. (AJDC. 1993;147:386-392)
Childhood screening for elevated cholesterol levels remains controversial. While the relationship between elevated blood cholesterol levels and the risk of coronary artery disease in adults is clear, there have been no long range studies on the benefits as adults of reducing cholesterol levels as children. Identifying children with high cholesterol levels does not predict coronary artery disease in later life, it predicts high cholesterol later in life. If mass screening were implemented, many children would be falsely labelled as having a high risk for coronary artery disease. Cholesterol screening is also complicated because cholesterol levels vary from day to day. Currently the National Cholesterol Education Program recommends selectively screening children at high risk, such as those whose parents or grandparents had premature heart disease.