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Cholesterol Screening of Children

Gianfranco Domenighetti; Antoine Casabianca; Fabrizio Barazzoni, MD; Peggy Lopipero, MPH
JAMA. 1991;265(24):3249. doi:10.1001/jama.1991.03460240042023.
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To the Editor.—  To the "cholesterol saga" presented in the December 19, 1990, issue of The Journal, we would like to add a "cost-misdeedness" analysis. The wave of enthusiasm for the beneficial effects of lowering blood cholesterol concentrations by pharmacological intervention in asymptomatic persons who are free of a history of coronary heart disease requires such an analysis.High plasma cholesterol levels are widely recognized as a major risk factor for heart disease and related mortality,1,2 but no evidence has yet been found that reducing cholesterol levels by drugs and diet can, in primary prevention trials, reduce total mortality.3Since total mortality and long life expectancy are still considered nontrivial end points and since cost containment is a major public policy concern, the worrisome results of the three largest randomized primary prevention drug trials4-8 seem to ask for time for us to reflect before we introduce interventions. A


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