Physicians should not use text messaging for medical interactions despite having an established patient except with extreme caution and consent by the individual. E-mail or other digital communications should only be used by physicians within an established patient-physician romantic relationship and with affected individual consent. Situations in which a physician is approached through digital means for clinical suggestions in the lack of a patient-physician romantic relationship should be managed with judgment and generally should be resolved with encouragement that the average person schedule an office check out or, in the full case of an urgent matter, visit the nearest emergency section.S4 in the Supplementary Appendix). Genotyping these three variants in the CGPS participants identified an additional 219 heterozygotes, totaling 260 heterozygotes in both studies combined . As compared with non-carriers of APOC3 mutations, heterozygotes for these mutations had mean reductions of 44 percent in levels of nonfasting triglycerides . Results were equivalent for the individual mutations. Heterozygotes, in comparison with noncarriers, also had mean reductions of 16 percent in apolipoprotein B levels and increases in degrees of HDL cholesterol and apolipoprotein A1 of 24 percent and 9 percent , respectively .