Childhood cholesterol disorders: the iceberg base or nondisease?

Pediatric cholesterol disorders are common, affecting 1 in 5 adolescents, although most are mild or moderate abnormalities. Because cholesterol values during childhood are moderately predictive of adult cholesterol levels, and are associated with atherosclerosis by pathology and by vascular testing, and because familial hyperlipidemias are associated with early cardiovascular events, cholesterol screening is recommended during childhood. Identified lipid abnormalities are an indication for lifestyle improvement and, in rare cases, pharmacotherapy. However, many gaps in the pediatric knowledge base remain about the benefits and risk, the optimal method for lipid screening, and about appropriate indications for pharmacotherapy.