Author's Response Universal Lipid Screening: In Response to Ongoing Debate

The 3 eLetters highlight concerns regarding the Expert Panel’s recommendation for universal screening of lipids in children.1 These concerns continue to be debated as noted in the commentary by Gillman and Daniels, both panel members with opposing viewpoints on this issue.2 The evidence for an important role of elevated low-density lipoprotein cholesterol in accelerated atherosclerosis beginning in childhood is extensive, and for adults, the benefits of lipid-lowering therapy are definitive. However, for children, the evidence for benefit is inferential, the long-term risks are unknown, and costs over a lifetime have not been projected. The number of assumptions that would have to be made to provide an estimate quantifying net benefit versus risks/costs would render conclusions suspect. Nonetheless, as stated in the guidelines, the panel agrees wholeheartedly that this screening should be pursued and informed by more definitive evidence. Our management of potential conflicts of interest did not conform …