Lipid Screening in Children.

SEE PAGE 1250 S creening for lipid disorders in childhood and adolescence has been controversial. Although it is well documented that atherosclerotic cardiovascular disease is the number 1 cause of death in the United States and that elevated cholesterol, particularly low-density lipoprotein cholesterol (LDL-C), is a major risk factor for the development of disease (1), many issues regarding screening in children remain in question. Various entities, such as the National Heart, Lung, and Blood Institute; the National Cholesterol Education Program; the American Academy of Pediatrics; and the National Lipid Association and the American Heart Association, have recommended some form of screening for lipid disorders in children (2). However, the U.S. Preventive Services Task Force has found insufficient evidence for or against cholesterol screening in childhood (3). Clearly, there is a need for more evidence to make the best clinical decisions. Several approaches to screening for lipid disorders in children have been proposed, including screening on the basis of family history, which is sometimes referred to as cascade screening, universal screening of all children, or no screening at all until later in adulthood. Even if one accepts that screening has merit, many questions remain, such as what is the goal of screening, what is the best age for screening, which lipid measure is most useful, and what cut point would be used to indicate abnormality? In lipid screening for adults, it is generally assumed that all measures in the lipid profile, including triglycerides, high-density lipoprotein cholesterol (HDL-C), and LDL-C, are important. It is also generally assumed that there is a continuous risk function so