To alter the adverse natural course of coronary artery disease and its risk factors, primary prevention should begin in childhood. High serum cholesterol, LDL cholesterol (LDL-C) in particular, remains the major determinant of atherosclerotic process beginning in childhood. Selective cholesterol screening of children based on family history is inadequate. Tracking of childhood elevated cholesterol in conjunction with other risk factors into adulthood argues in favor of universal screening in the young. Further, individual adverse levels of LDL-C not only increase the incidence of adulthood dyslipidemia, but also markedly enhances the prevalence of obesity and hypertension seen in the adult population. Screening of all young individuals for serum cholesterol along with a cardiovascular risk factor profile is recommended. Cardiovascular disease remains a public health issue and identifying young individuals at risk is basic to prevention.