Screening for hypercholesterolemia in children: the missing links.

A useful screening program depends on a serious and prevalent disease, an acceptable, valid, and reliable test, and an efficacious and cost-effective intervention in the population of interest. Although coronary heart disease is still the leading cause of death in the United States, screening children's lipids to detect those at high risk is problematic. Long-term studies starting in childhood have so far revealed less than optimal accuracy of a child's serum cholesterol to predict an adult level. Information regarding reliability of lipid measurements that could improve accuracy is sparse. No interventions have proven beneficial compared to current practice, and the costs of an extensive screening program, including misclassification, side effects, labeling, and treatment, are likely to be high. Until more information regarding these factors is available, widespread screening of serum cholesterol in children cannot be recommended.