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Kids, Cholesterol, Carotids, and Coronaries-Reply

Gerald S. Berenson, MD; Sathanur R. Srinivasan, PhD; Steven Shea, MD; Ken Resnicow, PhD
JAMA. 1991;266(17):2373-2374. doi:10.1001/jama.1991.03470170061021.
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In Reply.  —We concur with Dr Weintraub that research is needed to elucidate early biologic markers for determining future risk of coronary artery disease. However, this issue has little, if anything, to do with the specific points raised in our commentary or, in general, with the need to establish an effective public health policy for early detection and treatment of coronary artery disease.Epidemiologic studies of atherosclerosis and hypertension, unfortunately, do not provide direct causal risk factor-disease relationships. Similarly, serum lipids and lipoproteins and blood pressure in children are risk factor variables just as in adults, but their predictive values are less apt to be as precise since the timing of observations with morbidity and end-stage events is more distant. The closest our data correlate with disease is to show strong relationships of antemortem risk factors to fatty streaks and the more advanced raised coronary fibrous plaque lesions in autopsies


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