Routine cholesterol surveillance in childhood.

Coronary heart disease is the leading cause of death in the United States, and there is reason to believe that it begins in childhood. Evidence is accumulating that early diagnosis and treatment of hypercholesterolemia, a major coronary risk factor, can markedly reduce the incidence of atherosclerotic heart disease in later life. A pediatric group practice consisting of six pediatricians and a pediatric nurse practitioner performed a cholesterol surveillance study of 6500 children between 3 and 18 years of age. Parents and patients were counseled regarding other coronary risk factors, and the American Heart Association diet was recommended. According to the results of the study, 1251 children (19%) exceeded the acceptable 90th percentile for cholesterol and that 143 of 299 significantly hypercholesterolemic children (48%) had no family history of premature myocardial infarction or known hypercholesterolemia. The current recommendation is that only those children from high-risk families should be screened for an elevated cholesterol level. The authors conclude, as a result of this study, that all children older than 3 years of age should have a cholesterol test and that advice regarding avoidance of high-risk coronary life-style behaviors should be a routine part of pediatric anticipatory guidance.