and who do not respond adequately with 3 to 6 months of lifestyle therapy, it is reasonable to initiate statin IIa B-NR In children and adolescents with a family history of either early CVD* or significant hypercholesterolemia, it is reasonable to measure a fasting or nonfasting lipoprotein profile as early as age 2 years to detect FH or rare forms of IIa B-NR In children and adolescents found to have moderate or severe hypercholesterolemia, it is reasonable to carry out reverse-cascade screening of family members, which includes cholesterol testing for first-, second-, and when possible, third-degree biological relatives, for detection of familial forms of hy IIa C-LD In children and adolescents with obesity or other metabolic risk factors, it is reasonable to measure a fasting lipid profile to detect lipid disorders as components of the IIb B-NR In children and adolescents without cardiovascular risk factors or family history of early CVD, it may be reasonable to measure a fasting lipid profile or nonfasting non HDL-C once between the ages of 9 and 11 years, and again between the ages of 17 and 21 years, to detect moderate to severe lipid *Family history of early CVD is defined here as MI, documented angina, or atherosclerosis by angiography in parents, siblings, grandparents, aunts, or uncles (<55 years of age for men, <65 years of age for women). mmol/L), non HDL-C 220 mg/dL ( 5.7 mmol/L), or known primary hypercholesterolemia. Synopsis Abnormal lipid levels are relatively common in chil- dren and adolescents, affecting approximately 1 in 5 Confirmed lipid disorders are less common but occur frequently in the presence of obe- sity, often accompanied by cardiovascular risk factors, and contribute to increased rates of cardiovascular and metabolic morbidity and mortality. 