The atherosclerotic process begins in childhood and progresses slowly into adulthood. Aortic fatty streaks occur in individuals as young as 3 years old,1 and coronary fatty streaks occur in more than half of children aged 10 to 14 years. Approximately 8% of individuals aged 10 to 14 years have more advanced lesions.2,3 Pathologic studies4,5 have shown gross evidence of coronary disease in young soldiers killed in the Korean and Vietnam conflicts. Vascular changes have been shown to correlate with blood cholesterol levels in the Bogalusa Heart Study6,7 and in the Pathobiological Determinants of Atherosclerosis in Youth Program.8 Postmortem arterial lesions were positively related to antemortem lowdensity and very-low-density cholesterol levels and negatively related to antemortem high-density lipoprotein cholesterol levels. International data revealed that cholesterol levels in children vary geographically; in countries with high coronary heart diseaserelated