To the Editor.
—The commentary by Resnicow et al1 is confusing and misdirected. Scientific knowledge is currently inadequate in predicting that children with elevated cholesterol levels will become symptomatic adults. To focus only on cholesterol metabolism as the sole biologic marker for adult atherosclerosis appears unjustified.Atherosclerosis begins in childhood, yet the events that promote it are not completely understood. Previous knowledge relied upon autopsy data demonstrating fatty streaks and fibrous plaques in the aorta and coronary vessels.2 It would be misleading to conclude that the actual presence of plaque would correlate with future cardiovascular and cerebrovascular disease since the ischemic manifestations of elevated cholesterol and the presence of plaque are unpredictable and are not linearly related to stroke or heart disease. Thus, the search for alternative biological markers is reasonable and necessary.Current technology can now accurately measure coronary and carotid diameters, plaque, and blood flow. In
Weintraub MI. Kids, Cholesterol, Carotids, and Coronaries. JAMA. 1991;266(17):2373. doi:10.1001/jama.1991.03470170061020