The Committee on Nutrition of the American Academy of Pediatrics recently reiterated its recommendation that children and adolescents with a family history of high blood cholesterol or premature cardiovascular disease should be screened for high blood cholesterol.¹ In contrast, the American College of Physicians (ACP) does not recommend cholesterol screening in adults who may have familial hypercholesterolemia or other risk factors for coronary heart disease (CHD) until at least 25 to 30 years old in men and 35 to 40 years old in women.² Why the discrepant recommendations, and which ones should clinicians follow?

A review of the 2 sets of recommendations and their supporting documentation reveals a difference in the quality and quantity of evidence cited to support them. The ACP guideline is based on an exhaustive review of 45 clinical trials and 8 meta-analyses of cholesterol reduction. It includes projections of costs and of numbers-needed-to-treat to prevent 1 death in different risk groups.³ In contrast, the Committee on Nutrition statement primarily cites studies of cholesterol and arteriosclerosis in animals (7 references), cross-national comparisons (15 references), and studies of familial aggregation and tracking of cholesterol levels (16 references). The Committee on Nutrition does not quantify the costs or estimate the effects of the . . . [Full Text of this Article]