New Expert Panel Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents commissioned by the National Heart, Lung and Blood Institute (NHLBI) recommend universal lipid screening at 9 to 11 years of age and provide a comprehensive algorithm for evaluation and management of identified dyslipidemia.1 The universal screening can be performed with the child either nonfasting (measure total cholesterol and high-density lipoprotein cholesterol [HDL-C] levels, and calculate non-HDL cholesterol level) or fasting (full lipid profile with low-density lipoprotein cholesterol [LDL-C] and triglycerides). Targeted screening with a fasting lipid profile is recommended outside of universal screening for those children and adolescents with a positive family history of premature cardiovascular disease or events, or hyperlipidemia. Further evaluation and confirmation with fasting lipid profiles leads to initial management aimed at achieving optimal lifestyle behaviors, primarily a fat- and cholesterol-restricted diet. For those with persistent and significant lipid abnormalities, moderate- and high-level risk factors and risk conditions, including obesity, contribute to decision-making regarding initiation of lipid-lowering drug therapy at defined LDL-cholesterol cut points (Tables 1 and 2). Recent (2009–2010) National Health and Nutrition Examination Survey (NHANES) data indicate that 16.9% of American children ages 2 through 19 years are obese.2 Will the new guidelines result in an increased proportion of children and adolescents recommended for a statin, particularly among those who are obese? View this table: Table 1. Risk Factor Definitions for the Expert Panel Guidelines Dyslipidemia Algorithm We performed a cross sectional analysis of U.S. children ages 12 to 17 years who had fasting or nonfasting lipid measurement performed through NHANES data from 1999 to 2010.3 The results also provide information on blood pressure, smoking status, and body mass index (BMI). Calculation of the proportion of individuals who would be recommended for drug therapy based on the Expert Panel guidelines1 was …