This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Thomas B. Newman, MD, MPH; Alan M. Garber, MD, PhD; Neil A. Holtzman, MD, MPH; Stephen B. Hulley, MD, MPH

Arch Pediatr Adolesc Med. 1995;149(3):241-247.

Abstract
An Expert Panel convened by the National Cholesterol Education Program has recommended selective screening and treatment of children for high blood cholesterol levels, based on family history of cardiovascular disease or high blood cholesterol. This recommendation is problematic for several reasons. First, the recommended diets are likely to cause only a slight decrease in low-density lipoprotein cholesterol levels, the projected benefits of which will be offset by a similar decrease in high-density lipoprotein cholesterol levels. Lack of efficacy of the recommended diets could lead to use of more restrictive diets or to cholesterol lowering drugs. Second, even under optimistic assumptions, beneficial effects of cholesterol intervention will be small and delayed for many decades. As a result, childhood cholesterol-lowering efforts will not be cost-effective. Third, the Expert Panel's recommendations do not address important gender differences. Girls have higher average cholesterol levels than boys. They will therefore qualify for more dietary and drug treatment despite their lower age-adjusted risk of heart disease and the lack of association between cholesterol levels and cardiovascular mortality in women. Finally, recent evidence from randomized trials, cohort studies, and animal experiments suggests that cholesterol lowering may have serious adverse effects. This evidence was not discussed in the Expert Panel's report. Given current evidence, any screening and treatment of children for high blood cholesterol levels is, at best, premature.

(Arch Pediatr Adolesc Med. 1995;149:241-247)

Author Affiliations
From the Departments of Laboratory Medicine, Pediatrics, and Epidemiology and Biostatistics, and the Robert Wood Johnson Clinical Scholars Program, School of Medicine, University of California–San Francisco (Dr Newman); the Department of Medicine, Palo Alto Veterans Affairs Medical Center and Stanford University School of Medicine, Stanford, Calif (Dr Garber); the Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md (Dr Holtzman); and the Department of Epidemiology and Biostatistics, and Institute for Health Policy Studies, School of Medicine, University of California–San Francisco (Dr Hulley).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

If It's Not Worth Doing, It's Not Worth Doing Well
Newman
Pediatrics 2005;115:196-196.
FULL TEXT  

Cholesterol Guidelines Debate
Gidding; et al.
Pediatrics 2001;107:1229-1230.
FULL TEXT  

Origin of atherosclerosis in childhood and adolescence
McGill et al.
Am. J. Clin. Nutr. 2000;72 :1307S-1315S.
ABSTRACT | FULL TEXT  

Cholesterol Screening in Children and Adolescents
Newman and MD
Pediatrics 2000;105:637-638.
FULL TEXT  

Impact of Dietary Fat and Fiber Intake on Nutrient Intake of Adolescents
Nicklas et al.
Pediatrics 2000;105:21e-21.
ABSTRACT | FULL TEXT  

Garlic Extract Therapy in Children With Hypercholesterolemia
McCrindle et al.
Arch Pediatr Adolesc Med 1998;152:1089-1094.
ABSTRACT | FULL TEXT  

National Trends in the Management of Cardiovascular Disease Risk Factors in Children: Second NHLBI Survey of Primary Care Physicians
Kimm et al.
Pediatrics 1998;102:50e-50.
ABSTRACT | FULL TEXT  

School-based Interventions Improve Heart Health in Children With Multiple Cardiovascular Disease Risk Factors
Harrell et al.
Pediatrics 1998;102:371-380.
ABSTRACT | FULL TEXT  

Parent and Physician Response to Children's Cholesterol Values of 200 mg/dL or Greater: The Child and Adolescent Trial for Cardiovascular Health Experiment
Nader et al.
Pediatrics 1997;99:e5-e5.
ABSTRACT | FULL TEXT  

Effects of Serum Lipoproteins and Smoking on Atherosclerosis in Young Men and Women
McGill et al.
Arterioscler. Thromb. Vasc. Bio. 1997;17:95-106.
ABSTRACT | FULL TEXT  

Reducing Dietary Intake of Fat and Cholesterol in Children
Newman and Hulley
JAMA 1995;274:1424-1424.
ABSTRACT