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October 18, 1985, Vol 254, No. 15 >
ARTICLE | October 18, 1985

Multifactorial Primary Prevention of Cardiovascular Diseases in Middle-aged Men: Title and subTitle BreakRisk Factor Changes, Incidence, and Mortality FREE

Tatu A. Miettinen, MD; Jussi K. Huttunen, MD; Vesa Naukkarinen, MD; Timo Strandberg, MD; Seppo Mattila, MD; Torger Kumlin, MD; Seppo Sarna, PhD
[+] Author Affiliations

Read in part before the 54th Scientific Sessions of the American Heart Association, Dallas, Nov 17, 1981.

Reprint requests to Second Department of Medicine, University of Helsinki, 00290 Helsinki, Finland (Dr Miettinen).


JAMA. 1985;254(15):2097-2102. doi:10.1001/jama.1985.03360150073027
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References

In a randomized five-year multifactorial primary prevention trial of vascular diseases, hyperlipidemias, hypertension, smoking, obesity, and abnormal glucose tolerance of the high-risk test group (n=612 men) were treated with dietetic-hygienic measures and hypolipidemic (mainly probucol and clofibrate) and antihypertensive (mainly diuretics and β-blockers) agents. A matched high-risk control group (n=610) and a low-risk control group (n=593) were not treated. The program markedly improved the risk factor status, yet the five-year coronary incidence tended to be higher in the intervention group than in the control group (3.1% vs 1.5%), while the stroke incidence was significantly reduced (1.3% vs 0%). The coronary events tended to be accumulated in subgroups treated with β-blocking agents or clofibrate, but there were few in those receiving probucol or diuretics. Thus, the intervention program significantly reduced development of stroke, but the occurrence of cardiac events was not prevented. Possible adverse drug effects offsetting the probable benefit of improved risk profile are not excluded.

(JAMA 1985;254:2097-2102)

REFERENCES

1 +
Hjermann I, Velve Byre K, Holme I, et al:  Effect of diet and smoking intervention on the incidence of coronary heart disease: Report from the Oslo study group of a randomized trial in healthy men . Lancet 1981;;2:1303-1310.
2 +
Multiple Risk Factor Intervention Trial Research Group:  Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results . JAMA 1982;;248:1465-1477.
3 +
Rose G, Tunstall-Pedoe HD, Heller RF:  UK Heart Disease Prevention Project: Incidence and mortality results . Lancet 1983;;1:1062-1066.
4 +
Kornitzer M, DeBacker G, Dramaix M, et al:  Belgian Heart Disease Prevention Project: Incidence and mortality results . Lancet 1983;;1:1066-1070.
5 +
Naukkarinen V: The Feasibility of Administering Preventive Treatment for Coronary Heart Disease to Middle-aged Men, thesis. Helsinki, 1981.
6 +
Rose GA, Blackburn H: Cardiovascular Survey Methods , monograph series 56. Geneva, World Health Organization, 1968;.
7 +
Huang TC, Chen CP, Wefler V, et al:  A stable reagent for Liebermann Burchard reaction: Application to rapid serum cholesterol determination . Anal Chem 1961;;33:1405-1407.
8 +
Kessler G, Lederer H:  Fluorometric measurement of triglycerides , in Skeggs LT (ed): Automation in Analytical Chemistry . New York, Mediad, 1966;, pp 341-344.
9 +
Hultman E:  Rapid specific method for determination of aldosaccharides in body fluids . Nature 1959;;183:108-109.
10 +
von Röschla P, Bernt E, Gruber W:  Enzymatische Bestimmung des Gesamtcholesterins in Serum . Z Klin Chem Klin Biochem 1974;; 12:403-407.
11 +
Mantel N, Haenszel W:  Statistical aspects of the analysis of data from retrospective studies of disease . JNCI 1959;;22:719-748.
12 +
Keys A, Aravanis C, Blackburn H, et al:  Probability of middle-aged men developing coronary heart disease in five years . Circulation 1972;;45:815-828.
13 +
Cox DR:  Some procedures connected with the logistic qualitative response curve , in David FN (ed): Research Papers in Statistics . New York, John Wiley & Sons Inc, 1966;, p 55.
14 +
Huttunen JK, Pispa J, Kumlin T, et al:  Lack of correlation between serum dopamineβ-hydroxylase activity and blood pressure in middle-aged men . Hypertension 1979;;1:47-52.
15 +
Miettinen TA, Huttunen JK, Ehnholm C, et al:  Effect of long-term antihypertensive and hypolipidemic treatment on high density lipoprotein cholesterol and apolipoproteins A-I and A-II . Atherosclerosis 1980;;36:249-259.
16 +
Miettinen TA, Huttunen JK, Strandberg T, et al:  Lowered HDL cholesterol and incidence of ischaemic heart disease . Lancet 1981;;2:478.
17 +
Bloch DG, Heagerty AM, Bing RF, et al:  Effects of treatment for hypertension on cerebral haemorrhage and infarction . Br Med J 1984;;289:156-159.
18 +
Holme I, Helgeland A, Hjermann I, et al:  Socio-economic status as a coronary risk factor: The Oslo study . Acta Med Scand 1982;; (suppl 660) , pp 147-151.
19 +
Salonen JT, Puska P, Kottke TE, et al:  Decline in mortality from coronary heart disease in Finland from 1969 to 1979 . Br Med J 1983;; 286:1857-1860.
20 +
Jenkins CD:  Psychosocial risk factors for coronary heart disease . Acta Med Scand 1982;; (suppl 660) , pp 123-136.
21 +
Committee of Principal Investigators:  WHO cooperative trial on primary prevention of ischemic heart disease with clofibrate to lower serum cholesterol: Final mortality follow-up . Lancet 1984;;2:600-604.
22 +
Multiple Risk Factor Intervention Trial Research Group:  Baseline rest electrocardiographic abnormalities, antihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial . Am J Cardiol 1985;;55:1-15.
23 +
Helgeland A:  Treatment of mild hypertension: A five year controlled drug trial: The Oslo study . Am J Med 1980;;69:725-732.
24 +
Helgeland A, Hjermann I, Leren P, et al:  High density lipoprotein cholesterol and antihypertensive drugs: The Oslo Study . Br Med J 1978;;2:403.
25 +
Miettinen TA, Vanhanen H, Huttunen JK, et al:  HDL cholesterol and β-adrenoceptor blocking agents in a five year multifactorial primary prevention trial . Br J Clin Pharmacol 1982;; 13:431S-434S.
26 +
Lasser NI, Grandits G, Caggiula AW, et al:  Effects of antihypertensive therapy on plasma lipids and lipoproteins in the Multiple Risk Factor Intervention Trial . Am J Med 1984;; 76:52-66.
27 +
Ballantyne D, Ballantyne FC:  Thiazides, β-blockers and lipoproteins . Postgrad Med J 1983;;59:483-488.
28 +
Frishman WH, Furberg CD, Friedewald WT:  β-Adrenergic blockage for survivors of acute myocardial infarction . N Engl J Med 1984;;310:830-837.
29 +
Taylor SH, Silke B, Ebbutt A, et al:  A long-term prevention study with oxprenolol in coronary heart disease . N Engl J Med 1982;; 307:1293-1301.

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1 +
Hjermann I, Velve Byre K, Holme I, et al:  Effect of diet and smoking intervention on the incidence of coronary heart disease: Report from the Oslo study group of a randomized trial in healthy men . Lancet 1981;;2:1303-1310.
2 +
Multiple Risk Factor Intervention Trial Research Group:  Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results . JAMA 1982;;248:1465-1477.
3 +
Rose G, Tunstall-Pedoe HD, Heller RF:  UK Heart Disease Prevention Project: Incidence and mortality results . Lancet 1983;;1:1062-1066.
4 +
Kornitzer M, DeBacker G, Dramaix M, et al:  Belgian Heart Disease Prevention Project: Incidence and mortality results . Lancet 1983;;1:1066-1070.
5 +
Naukkarinen V: The Feasibility of Administering Preventive Treatment for Coronary Heart Disease to Middle-aged Men, thesis. Helsinki, 1981.
6 +
Rose GA, Blackburn H: Cardiovascular Survey Methods , monograph series 56. Geneva, World Health Organization, 1968;.
7 +
Huang TC, Chen CP, Wefler V, et al:  A stable reagent for Liebermann Burchard reaction: Application to rapid serum cholesterol determination . Anal Chem 1961;;33:1405-1407.
8 +
Kessler G, Lederer H:  Fluorometric measurement of triglycerides , in Skeggs LT (ed): Automation in Analytical Chemistry . New York, Mediad, 1966;, pp 341-344.
9 +
Hultman E:  Rapid specific method for determination of aldosaccharides in body fluids . Nature 1959;;183:108-109.
10 +
von Röschla P, Bernt E, Gruber W:  Enzymatische Bestimmung des Gesamtcholesterins in Serum . Z Klin Chem Klin Biochem 1974;; 12:403-407.
11 +
Mantel N, Haenszel W:  Statistical aspects of the analysis of data from retrospective studies of disease . JNCI 1959;;22:719-748.
12 +
Keys A, Aravanis C, Blackburn H, et al:  Probability of middle-aged men developing coronary heart disease in five years . Circulation 1972;;45:815-828.
13 +
Cox DR:  Some procedures connected with the logistic qualitative response curve , in David FN (ed): Research Papers in Statistics . New York, John Wiley & Sons Inc, 1966;, p 55.
14 +
Huttunen JK, Pispa J, Kumlin T, et al:  Lack of correlation between serum dopamineβ-hydroxylase activity and blood pressure in middle-aged men . Hypertension 1979;;1:47-52.
15 +
Miettinen TA, Huttunen JK, Ehnholm C, et al:  Effect of long-term antihypertensive and hypolipidemic treatment on high density lipoprotein cholesterol and apolipoproteins A-I and A-II . Atherosclerosis 1980;;36:249-259.
16 +
Miettinen TA, Huttunen JK, Strandberg T, et al:  Lowered HDL cholesterol and incidence of ischaemic heart disease . Lancet 1981;;2:478.
17 +
Bloch DG, Heagerty AM, Bing RF, et al:  Effects of treatment for hypertension on cerebral haemorrhage and infarction . Br Med J 1984;;289:156-159.
18 +
Holme I, Helgeland A, Hjermann I, et al:  Socio-economic status as a coronary risk factor: The Oslo study . Acta Med Scand 1982;; (suppl 660) , pp 147-151.
19 +
Salonen JT, Puska P, Kottke TE, et al:  Decline in mortality from coronary heart disease in Finland from 1969 to 1979 . Br Med J 1983;; 286:1857-1860.
20 +
Jenkins CD:  Psychosocial risk factors for coronary heart disease . Acta Med Scand 1982;; (suppl 660) , pp 123-136.
21 +
Committee of Principal Investigators:  WHO cooperative trial on primary prevention of ischemic heart disease with clofibrate to lower serum cholesterol: Final mortality follow-up . Lancet 1984;;2:600-604.
22 +
Multiple Risk Factor Intervention Trial Research Group:  Baseline rest electrocardiographic abnormalities, antihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial . Am J Cardiol 1985;;55:1-15.
23 +
Helgeland A:  Treatment of mild hypertension: A five year controlled drug trial: The Oslo study . Am J Med 1980;;69:725-732.
24 +
Helgeland A, Hjermann I, Leren P, et al:  High density lipoprotein cholesterol and antihypertensive drugs: The Oslo Study . Br Med J 1978;;2:403.
25 +
Miettinen TA, Vanhanen H, Huttunen JK, et al:  HDL cholesterol and β-adrenoceptor blocking agents in a five year multifactorial primary prevention trial . Br J Clin Pharmacol 1982;; 13:431S-434S.
26 +
Lasser NI, Grandits G, Caggiula AW, et al:  Effects of antihypertensive therapy on plasma lipids and lipoproteins in the Multiple Risk Factor Intervention Trial . Am J Med 1984;; 76:52-66.
27 +
Ballantyne D, Ballantyne FC:  Thiazides, β-blockers and lipoproteins . Postgrad Med J 1983;;59:483-488.
28 +
Frishman WH, Furberg CD, Friedewald WT:  β-Adrenergic blockage for survivors of acute myocardial infarction . N Engl J Med 1984;;310:830-837.
29 +
Taylor SH, Silke B, Ebbutt A, et al:  A long-term prevention study with oxprenolol in coronary heart disease . N Engl J Med 1982;; 307:1293-1301.

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