An Assessment of the New Lipid Screening Guidelines: In Reply

Abstract

The letter by Steiner et al in reference to the recently published “Lipid Screening and Cardiovascular Health in Childhood” clinical report from the American Academy of Pediatrics (AAP) Committee on Nutrition1 makes some useful points. Perhaps most important is the difficulty of making clinical recommendations when the evidence base is less than optimum. Unfortunately, this is a situation that we face often in pediatrics, and in fact, much of what pediatricians do in the area of prevention on a daily basis has less supporting evidence than one would like. Steiner et al provide points that are worthy of discussion. First, they ask if there is a causal relationship between childhood cholesterol levels and adult cardiovascular events? Although it is true that the definitive study has not been performed, it is also unlikely that it will be done, because this is a study with a 30- to 40-year duration. Steiner et al separate “merely atherosclerosis” from cardiovascular end points. It is doubtful that this distinction is helpful, because atherosclerosis is the proximate cause of cardiovascular events, and there is ample evidence that childhood cholesterol levels are closely linked with the development of atherosclerotic lesions early in life.2 It is also important to note that the first clinical event associated with atherosclerotic cardiovascular disease may be a sudden death. In addition, there are now studies linking risk-factor levels in childhood with markers of atherosclerosis in adulthood3 …