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Cholesterol Screening of Children-Reply

Thomas B. Newman, MD, MPH; Warren S. Browner, MD, MPH; Stephen B. Hulley, MD, MPH
JAMA. 1991;265(24):3248-3249. doi:10.1001/jama.1991.03460240042022.
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In Reply. —  We agree with Kashani and Nader that the emphasis of pediatric preventive cardiology should be on the adoption of a healthy life-style, including exercise and no smoking. But we disagree that dietary treatment to decrease blood cholesterol levels is known to be safe. The clinical trial evidence that cholesterol level reduction increases noncardiovascular mortality1,2 and the observational evidence that low cholesterol levels are associated with persistent increases in cancer incidence and mortality3 suggest that lowering children's cholesterol levels could increase their death rate. Such an increase would be likely to go undetected unless it occurred within a large clinical trial.4Stuhldreher et al believe that identification of children with familial hypercholesterolemia is justification enough for screening and that labeling will be no more of a problem for children with high cholesterol levels than it is for children with weight problems. However, labeling is a


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