I. Rationale for Attention to Cholesterol Levels in Children and Adolescents

Compelling evidence exists that the atherosclerotic process begins in childhood and progresses slowly into adulthood, at which time it leads frequently to coronary heart disease (CHD), the major cause of death in the United States. Despite an impressive decline in mortality during the past 20 years, CHD is still responsible for more than 500 000 deaths annually. Each year, approximately 1.25 million Americans suffer a myocardial infarction, and about 300 000 coronary artery bypass operations are performed. Moreover, an estimated 7 million Americans have symptomatic CHD, accounting for more than 10 million office visits and more than 2 million hospitalizations per year. About 20 percent of hospital discharges for acute CHD are for premature disease, ie, in patients younger than 55 years of age. Many of these adults have children who may have CHD risk factors that need attention. Estimates of the annual cost of CHD range from $41.5 to $56 billion. Elevated blood cholesterol levels are an important cause of atherosclerosis and CHD according to numerous studies. The need to lower blood cholesterol levels in adults was addressed in 1988 when the National Cholesterol Education Program (NCEP) published the Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. That report presented recommendations for lowering high cholesterol levels in individuals 20 years of age or older.1 The NCEP also has addressed blood cholesterol levels in the population as a whole; the Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction recommended an eating pattern low in saturated fatty acids (SFA), total fat, and cholesterol for all healthy Americans over the age of approximately 2 years2 to reduce average blood cholesterol levels in the United States.