Furthermore, moderately strong tracking of a risk factor over time does not translate into high sensitivity and specificity for the risk factor to predict later disease,5 and because the incidence of ischemic heart disease in young to middle-aged adults remains low, even a high sensitivity and specificity would still yield a low positive predictive value across the entire population. In other words, most children identified as having moderate dyslipidemia will not develop premature heart disease. The number of these "false positives," who accrue cost and risk but do not benefit from screening, will increase by expanding family history-directed screening to universal screening. Also, although the cost of a single lipid measure may appear trivial, major costs will ensue from aggregating over the population, thorough workups and long-term intervention. Even in randomized trials, behavioral interventions to achieve modest reductions in LDL-C require substantial resources.
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