Recently published guidelines from the National Cholesterol Education Program were applied to 792 men and 853 women aged 30 to 69 years who participated in Framingham Offspring examination 3 from 1983 to 1987. Using nationally recommended algorithms, cholesterol levels are desirable in 50% of men and women, borderline in 12% of men and 30% of women, and elevated in 35% of men and 19% of women. Assuming that diet reduces low-density lipoprotein cholesterol levels 20%, 10%, or 5%, rates of lipid medication use are projected as 2%, 5%, or 10%, respectively. Applying 6-year estimates of coronary risk derived from the original Framingham cohort to their offspring, the nationally recommended algorithm lacks specificity in women younger than 40 years and in both men and women older than 60 years. This study suggests that effective diet probably will be the cornerstone of current guidelines, and individuals aged 40 to 60 years might benefit most.