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ARTICLE |

Cholesterol Screening of Children FREE

Gianfranco Domenighetti; Antoine Casabianca; Fabrizio Barazzoni, MD; Peggy Lopipero, MPH
JAMA. 1991;265(24):3249-3249. 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

REFERENCES

Dawber TR. The Framingham Study: The Epidemiology of Atherosclerotic Disease . Cambridge, Mass: Harvard University Press; 1980;.
Keys A. Seven Countries: Multivariate Analysis of Death of Coronary Heart Disease . Cambridge, Mass: Harvard University Press; 1980;.
Muldoon MF, Manuck SB, Matthews KA.  Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials . BMJ. 1990;;301:309-314.
Committee of Principal Investigators.  A cooperative trial in the primary prevention of ischaemic heart disease using clofibrate . Br Heart J. 1978;;40:1069-1118.
Lipid Research Clinics Program.  The Lipid Research Clinics coronary primary prevention trial results . JAMA. 1984;;251:351-374.
Frick MH, Elo O, Haapa K, et al.  Helsinki Heart Study: primary-prevention trials with gemfibrozil in middle-aged men with dyslipidemia . N Engl J Med. 1987;;317:1237-1245.
Sempos C, Fulwood R, Haines C, et al.  The prevalence of high blood cholesterol levels among adults in the United States . JAMA. 1989;;262:45-52.
Schulman KA, Kinosian B, Jacobson TA, et al.  Reducing high blood cholesterol levels with drugs: cost-effectiveness of pharmacological management . JAMA. 1990;;264:3025-3033.
Bain SC, Lemon M, Jones AF.  Gemfibrozil-induced impotence . Lancet. 1990;;336:1389.
Brett AS.  Treating hypercholesterolemia: how should practicing physicians interpret the published data for patients? N Engl J Med. 1989;;314:512-514.
Hopkins PN, Willians RR.  A survey of 246 suggested coronary risk factors . Atherosclerosis. 1981;;40:1-52.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Dawber TR. The Framingham Study: The Epidemiology of Atherosclerotic Disease . Cambridge, Mass: Harvard University Press; 1980;.
Keys A. Seven Countries: Multivariate Analysis of Death of Coronary Heart Disease . Cambridge, Mass: Harvard University Press; 1980;.
Muldoon MF, Manuck SB, Matthews KA.  Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials . BMJ. 1990;;301:309-314.
Committee of Principal Investigators.  A cooperative trial in the primary prevention of ischaemic heart disease using clofibrate . Br Heart J. 1978;;40:1069-1118.
Lipid Research Clinics Program.  The Lipid Research Clinics coronary primary prevention trial results . JAMA. 1984;;251:351-374.
Frick MH, Elo O, Haapa K, et al.  Helsinki Heart Study: primary-prevention trials with gemfibrozil in middle-aged men with dyslipidemia . N Engl J Med. 1987;;317:1237-1245.
Sempos C, Fulwood R, Haines C, et al.  The prevalence of high blood cholesterol levels among adults in the United States . JAMA. 1989;;262:45-52.
Schulman KA, Kinosian B, Jacobson TA, et al.  Reducing high blood cholesterol levels with drugs: cost-effectiveness of pharmacological management . JAMA. 1990;;264:3025-3033.
Bain SC, Lemon M, Jones AF.  Gemfibrozil-induced impotence . Lancet. 1990;;336:1389.
Brett AS.  Treating hypercholesterolemia: how should practicing physicians interpret the published data for patients? N Engl J Med. 1989;;314:512-514.
Hopkins PN, Willians RR.  A survey of 246 suggested coronary risk factors . Atherosclerosis. 1981;;40:1-52.
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To understand the clinical management of acute heart failure syndromes.
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