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Dec 2012

Changing the Conversation Regarding Pediatric Cholesterol Screening: The Rare Disease Paradigm

Author Affiliations

Author Affiliations: Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Nutrition, Harvard School of Public Health; Boston, Massachusetts.

Arch Pediatr Adolesc Med. 2012;166(12):1097-1098. doi:10.1001/archpediatrics.2012.1907

In a debate at a meeting of the Pediatric Academic Societies in May 2012, I reiterated arguments against universal pediatric lipid screening because instituting the 2011 National Heart, Lung, and Blood Institute Expert Panel recommendations would identify a huge number of children who will never get heart disease, would require large amounts of resources, and would inflict torment on providers and patients for precious little return.1 During the ensuing discussion period, up to the microphone walked a 30-year-old woman who related her unexpected myocardial infarction some 5 years ago. Her poignant narrative reminded me of the first patient that I ever saw when I was a bright-eyed intern in the emergency department. He was 31 years old and had been dropped off by his wife for “ear pain” on her way to work. A few minutes later, he had a cardiac arrest and could not be resuscitated. These cases spotlight our dilemma regarding cardiovascular risk prevention starting early in life. How can we prevent these unanticipated cases of serious, sometimes fatal ischemic heart disease in young adults without weighing down an entire pediatric care system?