In Reply.—

With reference to our recent report that the current American Academy of Pediatrics (AAP) recommendation to use parental history of heart disease or elevated blood cholesterol to screen youth for hypercholesterolemia is not evidence-based, Drs Corwin and Boney highlight the need for new practice guidelines, and Dr Newman argues against cholesterol screening. Given the lack of useful screening criteria, we believe the issue that now needs debate, especially in the context of the ongoing pediatric obesity pandemic, is: Should all children be routinely tested for elevated low-density lipoprotein cholesterol (LDL-C)? This debate should center on understanding the costs and benefits of systematic routine testing.

What are the potential costs of not systematically testing all children? Elevated LDL-C is causally related to atherosclerosis, and several studies have established that the atherosclerosis process begins in early infancy and continues into adulthood with clinical manifestations in middle age.2...

You do not currently have access to this content.