Common carotid intima-media thickness was measured by B-mode ultrasound imaging in 46 children (mean age, 7.4 years) with serum cholesterol 26.4 mmol/L (mean, 8.25 mmol/L) and in 48 children (mean age, 6.4 years) with serum cholesterol <6.4 mmol/L (mean, 4.60 mmol/L). Maximum thickness was significantly higher in hypercholesterolemic children than in control children (0.50 versus 0.47 mm, P=.007). Subgroup analysis showed that only in children >6.2 years old (the median of all the children's ages) was maximum thickness significantly higher in hypercholesterolemic children than in control children (0.51 versus 0.48 mm, P=.O14). The odds ratio (OR) of common carotid intima-media thickening T he relationship between hypercholesterolemia and coronary artery diseases (CAD) has been proved in adult CAD patients. 1 " 3 The significance of this relationship is more controversial in healthy subjects, particularly if their serum cholesterol is <6.4 mmol/L, 4 -6 Children form a special subgroup of healthy individuals.Population-based or "high-risk"-based screenings for serum cholesterol are usually recommended, 710 although others oppose this view on the basis of potential harm and of nonproven efficacy in the prevention of adult CAD.
1112Autopsy studies on arterial specimens of human subjects have shown that fatty streaks (nonraised lesions) can be found in the aortas even of 3-year-olds 13 and appear in the coronary arteries during the second decade of life.14 More advanced coronary atherosclerosis was seen in a majority of young adults in whom autopsies were performed during the Korean and Vietnam wars.
-16 Aortic fatty streaks detected in subjects who had died between full-term birth and age 29 years appeared to be strongly related to antemortem levels of both total and low-density lipoprotein (LDL) cholesterol. 17 Raised lesions, like fibrous plaques, are related to clinical CAD, 18 but the progression of fatty streaks to fibrous plaques is uncertain. Arterial fibrous plaques have been found in autopsy specimens from children, Received October 5, 1993; revision accepted March 25, 1994. From the Institute of Internal Medicine and Metabolic Diseases and the Department of Pediatrics (R.S., A. Di C), Federico II University, Naples, Italy.Correspondence to Dr Paolo Pauciullo, Institute of Internal Medicine and Metabolic Diseases, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.© 1994 American Heart Association, Inc.(maximum thickness of the far wall higher than the 95th percentile of the control group, 0.51 mm) between patients and control subjects was statistically significant both in univariate analysis (OR, 6.39; 95% confidence interval, 1.19 to 32.3; f>=.025) and after age (OR, 5.96; 95% confidence interval, 1.09 to 32.4; P=.O39) and sex (OR, 7.54; 95% confidence interval, 1.38 to 41.2; P=.02O) were controlled for. Children >6 years old with serum cholesterol ^6.4 mmol/L show increased thickness of the common carotid intima-media.