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COMMENTARY:
Thomas B. Newman and Alan M. Garber MD
Cholesterol Screening in Children and Adolescents
Pediatrics 2000; 105: 637-638 [Full text] [PDF]
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eLetters published:

[Read eLetters] Pediatric Cholesterol Screening is Adult Case Finding
David Hamburger   (2 March 2000)
[Read eLetters] Response to Dr. Hamburger
Thomas B Newman   (8 March 2000)

Pediatric Cholesterol Screening is Adult Case Finding 2 March 2000
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David Hamburger,
Medical Director
Aetna US Health Care

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Re: Pediatric Cholesterol Screening is Adult Case Finding

davidham{at}capaccess.org David Hamburger

The opinions expressed herein are personal and should not be construed as representing the opinion of Aetna, Inc., Aetna US Health Care, its employees, or any of its subsidiaries.

The advantages of routine screening of the pediatric population for hypercholesterolemia is several fold:

1)Identification of a possibly elevated cholesterol offers the pediatrician the opportunity of discussing healthy diet behavior, the benefits of exercise, and moderation of salt intake within a patient specific context.

2)These same health promotion opportunities may also be extended to the entire family.

3)The "index pediatric case" of hypercholesterolemia allows for the suggestion that parents (who may be in their early 20"s) be screened by their physicians.

David Hamburger, MD, FAAP

Response to Dr. Hamburger 8 March 2000
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Thomas B Newman,
Professor of Epidemiology and Biostatistics and Pediatrics
School of Medicine, UCSF

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Re: Response to Dr. Hamburger

newman{at}itsa.ucsf.edu Thomas B Newman

The advantages of childhood cholesterol screening suggested by Dr. Hamburger do not justify the risks and costs.

1. Pediatricians wishing to discuss the benefits of a healthy diet and exercise can do so at less cost and risk by providing the counseling to all children. Cholesterol screening inappropriately singles out some children for counseling on the basis of a measurement that provides little useful information about future heart disease risk.

2. Screening children to identify adults with hypercholesterolemia is unfair to the children and neither sensitive nor specific as a predictor of adult hypercholesterolemia. The adults may be screened at about age 35 (for men) and 45 (for women), as recommended in the current evidence-based recommendations of the American College of Physicians.

Thomas B. Newman, MD, MPH

Alan M. Garber, MD, PhD