PROBLEMS WITH THE REPORT OF THE EXPERT PANEL ON BLOOD CHOLESTEROL LEVELS IN CHILDREN AND ADOLESCENTS

An Expert Panel convened by the National Cholesterol Education Program has recommended selective screening and treatment of children for hig h blood cholesterol levels, based on family history of cardiovascular disease or high blood cholesterol. This recommendation is problematic for several reasons. First, the recommended diets are likely to cause only a slight decrease in low-density lipoprotein cholesterol levels, the projected benefits of which will be offset by a similar decrease i n high-density lipoprotein cholesterol levels, Lack of efficacy of the recommended diets could lead to use of more restrictive diets or to c holesterol lowering drugs. Second, even under optimistic assumptions, beneficial effects of cholesterol intervention will be small and delay ed for many decades. As a result, childhood cholesterol-lowering effor ts will. not be cost-effective. Third, the Expert Panel's recommendati ons do not address important gender differences. Girls have higher ave rage cholesterol levels than boys. They will therefore qualify for mor e dietary and drug treatment despite their lower age-adjusted risk of heart disease and the lack of association between cholesterol levels a nd cardiovascular mortality in women. Finally, recent evidence from ra ndomized trials, cohort studies, and animal experiments suggests that cholesterol lowering may have serious adverse effects. This evidence w as not discussed in the Expert Panel's report. Given current evidence, any screening and treatment of children for high blood cholesterol le vels is, at best, premature.