Cardiovascular disease remains a substantial health care burden in the adult population, the roots of which begin in childhood. Universal screening for dyslipidemia in all children and adolescents has been implemented to identify cases of FH that are otherwise missed by conventional screening because untreated FH can result in early CVD and untimely death. Recommendations for medical therapy did not change with the 2011 NHLBI guidelines. LDL levels targeted for therapy usually are elevated because of primary genetic disorders such as FH. Although these recommendations remain controversial, the benefit of universal screening and subsequent treatment of high-risk patients far outweighs the risk of not screening, although more investigation is warranted to understand the long-term outcomes of CVD risk in youth.