This is one in a series of pro/con editorials discussing controversial issues in family medicine.

Cardiovascular disease is the leading cause of death in the United States. There is substantial evidence that the atherosclerotic process begins in childhood, with the presence of fatty streaks in the aorta by 10 years of age and in the coronary arteries by 20 years of age.1 Atherosclerotic lesions, which occur in up to 38 percent of persons with multiple risk factors, are more common in young persons with elevations in serum total cholesterol and low-density lipoprotein (LDL) levels; body mass index; and systolic and diastolic blood pressures.2–4

Furthermore, studies in adolescents have shown that mean carotid intimamedia thickness measured by ultrasonography is strongly associated with cardiovascular risk factors and predictive of coronary artery disease and cerebrovascular accidents. Most of these studies evaluated persons with familial hypercholesterolemia in whom carotid intimamedia thickness was increased and the rate of change was much greater than in the control population.5

The percentage of children with hyperlipidemia appears to be increasing. Data from the National Health and Nutrition Examination Survey between 1988 and 1994 found that 10 percent of adolescents had total cholesterol levels greater than 200 mg per dL (5.18 mmol per L).6 In the more recent Child and Adolescent Trial for Cardiovascular Health, 13.3 percent of children nine to 10 years of age had total cholesterol levels greater than 200 mg per dL.7 Despite no long-term studies evaluating the effectiveness of screening for dyslipidemia in childhood and its effect in delaying or reducing the incidence of cardiovascular-related events, the American Academy of Pediatrics released an updated clinical policy statement in 2008 on lipid screening and cardiovascular health in childhood. The recommendations are summarized in Table 1.8,9