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In Reply. —
We agree with Kashani and Nader, Stuhldreher et al, and Shannon et al that preventive cardiology is an important effort. Kashani and Nader point out that the majority of coronary heart disease occurs in low- and moderate-risk groups who make up a large proportion of the population. We also believe that this large group does deserve attention to their nutrition. The population approach to lower cholesterol levels in all children over 2 years of age has been endorsed by several consensus groups, including the American Heart Association and the National Cholesterol Education Program. Promotion of nutrition education, attention to school breakfast and lunch programs, provision of low-fat snack foods, prevention of smoking, and the reduction of obesity and other risk factors may be accomplished without the need to measure all children's cholesterol levels.With respect to the letter by Stuhldreher et al, we believe that we have
Lauer RM, Clarke WB. Cholesterol Screening of Children-Reply. JAMA. 1991;265(24):3248. doi:10.1001/jama.1991.03460240042021