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Coronary heart disease (CHD) remains the number one killer in the United States. This article summarizes the recommendations for cholesterol screening of children and adolescents by the American Academy of Pediatrics and the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Screening of children and adolescents is selective, and the determination to screen is based on past medical, family health, and health behavior histories. Children or adolescents with a family history of peripheral vascular disease or coronary artery disease in primary relatives under 55 years of age, or parents with high blood cholesterol levels, are considered to be at risk for high blood cholesterol and in need of screening. Children or adolescents who are obese, inactive, have hypertension or diabetes, or who smoke are also considered to be at risk. A universal approach to the prevention of CHD through diet and lifestyle is also described.