To the Editor.—We disagree with Dr Strong's1 recommendation that pediatricians screen all children for high blood cholesterol. Our opposition to childhood cholesterol screening is based on an assessment of the evidence as to the benefits and adverse effects of such a policy.
Proponents of screening believe that identifying children with high blood cholesterol conveys information about their risk of developing coronary heart disease (CHD) many decades later, and that this could lead to interventions that would prevent CHD more effectively if begun in childhood than if begun as an adult. However, the evidence does not support this belief. For one thing, even in carefully performed research studies the association between cholesterol measured in childhood and cholesterol measured only 10 to 20 years later is far from perfect. In the Muscatine study,2 for example, fewer than half of the children with cholesterol in the top 10% of the