In Reply.—The letter by Drs Newman, Browner, and Hulley is much appreciated. They raised several important issues and provided an opportunity to expand on the rationale for screening children's total serum cholesterol levels in an office setting (eg, pediatrician, family practitioner, clinic).
The data of Lauer et al1 cited in their letter are among the strongest to support the importance of tracking. Adults whose total cholesterol (TC) level exceeds the 95th percentile account for only a small percentage of coronary artery mortality. The vast majority of deaths occur at values that are between the 50th and 95th percentiles. Eighty-three percent of the youngsters described by Lauer et al who were initially above the 90th percentile were above the 50th percentile when measured as young adults. Those youngsters, therefore, become adults at increased risk of coronary artery disease (CAD). Additionally, the distribution of TC in the United States is