A variety of studies indicate that the process of atherosclerosis begins in childhood, that this process is related to elevated levels of blood cholesterol, and that these levels are often predictive of elevated blood cholesterol in adulthood. Despite substantial success in reducing mortality due to coronary heart disease (CHD) in the past two decades, this disease remains the leading cause of death in the United States. Preventing or slowing the atherosclerotic process in childhood and adolescence could extend the years of healthy life for many Americans.

THE SIGNIFICANCE OF BLOOD CHOLESTEROL LEVELS IN CHILDHOOD AND ADOLESCENCE

High blood cholesterol levels clearly play a role in the development of CHD in adults. This has been established by many laboratory, clinical, pathologic, and epidemiologic studies. A variety of studies also have demonstrated that the atherosclerotic process begins in childhood and is affected by high blood cholesterol levels. The evidence can be summarized as follows:

• Compared to their counterparts in many other countries, US children and adolescents have higher blood cholesterol levels and higher intakes of saturated fatty acids and cholesterol, and US adults have higher blood cholesterol levels and higher rates of CHD morbidity and mortality.

• Autopsy studies demonstrate that early coronary atherosclerosis or precursors of atherosclerosis often begin in childhood and adolescence.

• High serum total cholesterol, low-density lipoprotein (LDL) cholesterol, and very-low-density lipoprotein (VLDL) cholesterol levels, and low high-density lipoprotein (HDL) cholesterol levels, are correlated with the extent of early atherosclerotic lesions in adolescents and young adults.

• Children and adolescents with elevated serum cholesterol, particularly LDL-cholesterol levels, frequently come from families in which there is a high incidence of CHD among adult members.

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