1 The Johns Hopkins University, School of Medicine, Baltimore
Evidence that the seeds of destruction from coronary disease are sown in childhood1,2 may tempt pediatricians to identify children at risk and intervene in order to improve their survival as adults. There are traps along the way and before proceeding two questions must be considered: Can children at risk be identified? Are current interventions effective?
The routine determination of serum lipids offers one approach to identification. Approximately 32% of adults who have myocardial infarctions before age 60 have either hypercholesterolemia (10%), hypertriglyceridemia (11%), or both (11%).3 Coronary disease patients with the latter two conditions are less likely to express their abnormality in childhood than those with only hypercholesterolemia,2 and hypertriglyceridemia may not be a risk factor for coronary disease.4