FIGURE 3
Sample screen from Cholesterol 1.1
Conclusion
In summary, all 3 options “work.” All are meant to facilitate implementation of the ATP III guidelines. For physicians who wish to use ATP III guidelines to support their therapeutic decisions, all of these options simplify calculation and are better than simply guessing about whether—and which—therapy is appropriate. Regarding the 2 applications for the Palm operating system, Stat Cholesterol has a few more screens than NIH-ATP3, but these serve as helpful reminders about metabolic syndrome and triglyceride levels. Stat Cholesterol’s unique features include choice of units (mmol/L, mg/dL) and “real time” changes in 10-year risk numbers as data are entered or modified. NIH-ATP3 is the “cleanest” and simplest in my opinion. For physicians who have the computer resources and most especially for those who want personalized, printed information for the patient or chart (and are willing to enter these additional data), Cholesterol 1.1 for desktop computers is the way to go.
It is important to remember that the Framingham model was developed in individuals without known established CHD, and consisted largely of non-Hispanic white patients; thus data may not be entirely generalizable to other groups. In 1997, the American Diabetes Association2 also lowered the fasting glucose levels defining diabetes from 140 to 126 mg/dL; thus, the “mildest” forms of diabetes may not have the same prognostic significance. Finally, just because a population with a total cholesterol level of 280 mg/dL has one risk and a population with a total cholesterol level of 220 mg/dL has a lower risk, does not automatically mean that lowering the 280 cholesterol group’s cholesterol to 220 reduces their risk to that of the group whose innate cholesterol level was 220. However, it is tempting to use these data that way.
Finally, the NCEP ATP III tables offer recommendations only through age 79. Cholesterol 1.1 handles ages 80 and above improperly, but provides no error message or explanation. Stat Cholesterol allows only fixed choices from its drop-down menus; for age, these stop at age 79. NIH-ATP III appears to apply the risk values for age 79 to older individuals without modification (or notification to the user), although the product information specifies an age range up to 99 years.