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February 19, 1997, Vol 277, No. 7 >
ARTICLE | February 19, 1997

Multiple Risk Factor Intervention Trial: Title and subTitle BreakRisk Factor Changes and Mortality Results FREE

[+] Author Affiliations

Reprint requests to MRFIT Coordinating Center, Biometry Division, University of Minnesota, School of Public Health, Room 508, 2829 University Ave SE, Minneapolis, MN 55414 (Marcus O. Kjelsberg, PhD).


JAMA. 1997;277(7):582-594. doi:10.1001/jama.1997.03540310080040
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References

• The Multiple Risk Factor Intervention Trial was a randomized primary prevention trial to test the effect of a multifactor intervention program on mortality from coronary heart disease (CHD) in 12,866 high-risk men aged 35 to 57 years. Men were randomly assigned either to a special intervention (SI) program consisting of stepped-care treatment for hypertension, counseling for cigarette smoking, and dietary advice for lowering blood cholesterol levels, or to their usual sources of health care in the community (UC). Over an average follow-up period of seven years, risk factor levels declined in both groups but to a greater degree for the SI men. Mortality from CHD was 17.9 deaths per 1,000 in the SI group and 19.3 per 1,000 in the UC group, a statistically nonsignificant difference of 7.1% (90% confidence interval, -15% to 25%). Total mortality rates were 41.2 per 1,000 (SI) and 40.4 per 1,000 (UC). Three possible explanations for these findings are considered: (1) the overall intervention program, under these circumstances, does not affect CHD mortality; (2) the intervention used does affect CHD mortality, but the benefit was not observed in this trial of seven years' average duration, with lower-than-expected mortality and with considerable risk factor change in the UC group; and (3) measures to reduce cigarette smoking and to lower blood cholesterol levels may have reduced CHD mortality within subgroups of the SI cohort, with a possibly unfavorable response to antihypertensive drug therapy in certain but not all hypertensive subjects. This last possibility was considered most likely, needs further investigation, and lends support to some preventive measures while requiring reassessment of others.

REFERENCES

1 +
Arteriosclerosis: A Report by the National Heart and Lung Institute Task Force on Arteriosclerosis , vol 1, US Dept of Health, Education, and Welfare publication No. (NIH) 72-137. Washington, DC, National Institutes of Health, 1971;.
2 +
Zukel WJ, Paul O, Schnaper HW:  The Multiple Risk Factor Intervention Trial (MRFIT): I. Historical perspectives . Prev Med 1981;;10:387-401.
3 +
Sherwin R, Kaelber CT, Kezdi P, et al:  The Multiple Risk Factor Intervention Trial (MRFIT): II. The development of the protocol . Prev Med 1981;;10:402-425.
4 +
 The Multiple Risk Factor Intervention Trial Group: Statistical design considerations in the NHLI Multiple Risk Factor Intervention Trial . J Chronic Dis 1977;;30:261-275.
5 +
Rose GA, Blackburn H: Cardiovascular Survey Methods, World Health Organization Monograph Series, No. 56. Geneva, 1968.
6 +
Benfari RC:  The Multiple Risk Factor Intervention Trial (MRFIT): III. The model for intervention . Prev Med 1981;;10:426-442.
7 +
Caggiula AW, Christakis G, Farrand M, et al:  The Multiple Risk Factor Intervention Trial (MRFIT): IV. Intervention on blood lipids . Prev Med 1981;;10:443-475.
8 +
Hughes GH, Hymowitz N, Ockene JK, et al:  The Multiple Risk Factor Intervention Trial (MRFIT): V. Intervention on smoking . Prev Med 1981;;10:476-500.
9 +
Cohen JD, Grimm RH Jr, Smith WM:  The Multiple Risk Factor Intervention Trial (MRFIT): VI. Intervention on blood pressure . Prev Med 1981;;10:501-518.
10 +
Butts WC, Kuehneman M, Widdowson GM.  Automated method for determining serum thiocyanate to distinguish smokers from nonsmokers . Clin Chem 1974;;20:1344-1348.
11 +
Manual of Laboratory Operations, vol 1, Lipid Research Clinics Program, US Dept of Health, Education, and Welfare publication No. DHEW (NIH) 75-628. Washington, DC, National Institutes of Health, 1974.
12 +
Blackburn H (ed): Measurement in Exercise Electrocardiography , Springfield, Ill, Charles C Thomas Publisher, 1969;.
13 +
Neaton JD, Broste S, Cohen L, et al.  The Multiple Risk Factor Intervention Trial (MRFIT): VII. a comparison of risk factor changes between the two study groups . Prev Med 1981;;10:519-543.
14 +
Dennis B, Ernst N, Hjortland M, et al:  The NHLBI nutrition data system . J Am Diet Assoc 1980;;77:641-647.
15 +
Eisinger RA:  Psychosocial predictors of smoking behavior change . Soc Sci Med 1972;; 6:137-144.
16 +
Kaplan E, Meier P:  Non-parametric estimation from incomplete observations . J Am Stat Assoc 1958;;53:457-481.
17 +
Mantel N:  Evaluation of survival data and two new rank order statistics arising in its considerations . Cancer Chemother Rep 1966;;50:163-170.
18 +
Bross I:  A confidence interval for a percentage increase . Biometrics 1954;;10:245-250.
19 +
Report of the Working Group on Arteriosclerosis of the National Heart, Lang, and Blood Institute: Arteriosclerosis 1981 , vol 2, NIH publication 82-2035. Bethesda, Md, National Institutes of Health, 1981;.
20 +
Rose G, Hamilton PJS, Colwell L, et al:  A randomised controlled trial of antismoking advice: Ten-year results . J Epidemiol Community Health 1982;;36:102-108.
21 +
Kuller L, Meilahn E, Townsend M, et al:  Control of cigarette smoking from a medical perspective . Ann Rev Public Health 1982;;3:153-178.
22 +
Rogot E, Murray JL:  Smoking and causes of death among US veterans: 16 years of observation . Public Health Rep 1980;;95:213-222.
23 +
Hypertension Detection and Follow-up Program Cooperative Group:  Five-year findings of the Hypertension Detection and Follow-up Program: I. Reduction in mortality of persons with high blood pressure, including mild hypertension . JAMA 1979;;242:2562-2571.
24 +
Hypertension Detection and Follow-up Program Cooperative Group:  Five-year findings of the Hypertension Detection and Follow-up Program: II. Mortality by race-sex and age . JAMA 1979;;242:2572-2577.
25 +
Report by the Management Committee:  The Australian Therapeutic Trial in Mild Hypertension . Lancet 1980;;1:1261-1267.
26 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents:  Effects of treatment on morbidity in hypertension: II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg . JAMA 1970;;213:1143-1152.
27 +
Report of Inter-Society Commission for Heart Disease Resources:  Primary prevention of the atherosclerotic diseases . Circulation 1970;;42:A55-A95.
28 +
Grundy SM, Bilheimer D, Blackburn H, et al:  Rationale of the diet-heart statement of the American Heart Association, Report of Nutrition Committee . Circulation 1982;;65:839A-854A.
29 +
Stamler J:  Lifestyles, major risk factors, proof and public policy . Circulation 1978;;58:3-19.
30 +
Dayton S, Pearce ML, Hashimoto S, et al:  Controlled clinical trial of a diet high in unsaturated fat in preventing complications of atherosclerosis . Circulation 1969;;39/40( (suppl 12) ):1-63.
31 +
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.
32 +
Grimm R, Leon A, Hunninghake D, et al:  Effects of thiazide diuretics on plasma lipids and lipoproteins in mildly hypertensive patients . Ann Intern Med 1981;;94:7-11.
33 +
 LRC Program-Laboratory Methods Committee: Cholesterol and triglyceride concentrations in serum/plasma pairs . Clin Chem 1977;;23:60-63.
34 +
Prineas R, Crow R, Blackburn H. The Minnesota Code Manual: Procedures for Measurement and Classification of Electrocardiographic Findings in Clinical Trials and Population Studies . Littleton, Mass, John Wright-PSG, 1982;.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Arteriosclerosis: A Report by the National Heart and Lung Institute Task Force on Arteriosclerosis , vol 1, US Dept of Health, Education, and Welfare publication No. (NIH) 72-137. Washington, DC, National Institutes of Health, 1971;.
2 +
Zukel WJ, Paul O, Schnaper HW:  The Multiple Risk Factor Intervention Trial (MRFIT): I. Historical perspectives . Prev Med 1981;;10:387-401.
3 +
Sherwin R, Kaelber CT, Kezdi P, et al:  The Multiple Risk Factor Intervention Trial (MRFIT): II. The development of the protocol . Prev Med 1981;;10:402-425.
4 +
 The Multiple Risk Factor Intervention Trial Group: Statistical design considerations in the NHLI Multiple Risk Factor Intervention Trial . J Chronic Dis 1977;;30:261-275.
5 +
Rose GA, Blackburn H: Cardiovascular Survey Methods, World Health Organization Monograph Series, No. 56. Geneva, 1968.
6 +
Benfari RC:  The Multiple Risk Factor Intervention Trial (MRFIT): III. The model for intervention . Prev Med 1981;;10:426-442.
7 +
Caggiula AW, Christakis G, Farrand M, et al:  The Multiple Risk Factor Intervention Trial (MRFIT): IV. Intervention on blood lipids . Prev Med 1981;;10:443-475.
8 +
Hughes GH, Hymowitz N, Ockene JK, et al:  The Multiple Risk Factor Intervention Trial (MRFIT): V. Intervention on smoking . Prev Med 1981;;10:476-500.
9 +
Cohen JD, Grimm RH Jr, Smith WM:  The Multiple Risk Factor Intervention Trial (MRFIT): VI. Intervention on blood pressure . Prev Med 1981;;10:501-518.
10 +
Butts WC, Kuehneman M, Widdowson GM.  Automated method for determining serum thiocyanate to distinguish smokers from nonsmokers . Clin Chem 1974;;20:1344-1348.
11 +
Manual of Laboratory Operations, vol 1, Lipid Research Clinics Program, US Dept of Health, Education, and Welfare publication No. DHEW (NIH) 75-628. Washington, DC, National Institutes of Health, 1974.
12 +
Blackburn H (ed): Measurement in Exercise Electrocardiography , Springfield, Ill, Charles C Thomas Publisher, 1969;.
13 +
Neaton JD, Broste S, Cohen L, et al.  The Multiple Risk Factor Intervention Trial (MRFIT): VII. a comparison of risk factor changes between the two study groups . Prev Med 1981;;10:519-543.
14 +
Dennis B, Ernst N, Hjortland M, et al:  The NHLBI nutrition data system . J Am Diet Assoc 1980;;77:641-647.
15 +
Eisinger RA:  Psychosocial predictors of smoking behavior change . Soc Sci Med 1972;; 6:137-144.
16 +
Kaplan E, Meier P:  Non-parametric estimation from incomplete observations . J Am Stat Assoc 1958;;53:457-481.
17 +
Mantel N:  Evaluation of survival data and two new rank order statistics arising in its considerations . Cancer Chemother Rep 1966;;50:163-170.
18 +
Bross I:  A confidence interval for a percentage increase . Biometrics 1954;;10:245-250.
19 +
Report of the Working Group on Arteriosclerosis of the National Heart, Lang, and Blood Institute: Arteriosclerosis 1981 , vol 2, NIH publication 82-2035. Bethesda, Md, National Institutes of Health, 1981;.
20 +
Rose G, Hamilton PJS, Colwell L, et al:  A randomised controlled trial of antismoking advice: Ten-year results . J Epidemiol Community Health 1982;;36:102-108.
21 +
Kuller L, Meilahn E, Townsend M, et al:  Control of cigarette smoking from a medical perspective . Ann Rev Public Health 1982;;3:153-178.
22 +
Rogot E, Murray JL:  Smoking and causes of death among US veterans: 16 years of observation . Public Health Rep 1980;;95:213-222.
23 +
Hypertension Detection and Follow-up Program Cooperative Group:  Five-year findings of the Hypertension Detection and Follow-up Program: I. Reduction in mortality of persons with high blood pressure, including mild hypertension . JAMA 1979;;242:2562-2571.
24 +
Hypertension Detection and Follow-up Program Cooperative Group:  Five-year findings of the Hypertension Detection and Follow-up Program: II. Mortality by race-sex and age . JAMA 1979;;242:2572-2577.
25 +
Report by the Management Committee:  The Australian Therapeutic Trial in Mild Hypertension . Lancet 1980;;1:1261-1267.
26 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents:  Effects of treatment on morbidity in hypertension: II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg . JAMA 1970;;213:1143-1152.
27 +
Report of Inter-Society Commission for Heart Disease Resources:  Primary prevention of the atherosclerotic diseases . Circulation 1970;;42:A55-A95.
28 +
Grundy SM, Bilheimer D, Blackburn H, et al:  Rationale of the diet-heart statement of the American Heart Association, Report of Nutrition Committee . Circulation 1982;;65:839A-854A.
29 +
Stamler J:  Lifestyles, major risk factors, proof and public policy . Circulation 1978;;58:3-19.
30 +
Dayton S, Pearce ML, Hashimoto S, et al:  Controlled clinical trial of a diet high in unsaturated fat in preventing complications of atherosclerosis . Circulation 1969;;39/40( (suppl 12) ):1-63.
31 +
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.
32 +
Grimm R, Leon A, Hunninghake D, et al:  Effects of thiazide diuretics on plasma lipids and lipoproteins in mildly hypertensive patients . Ann Intern Med 1981;;94:7-11.
33 +
 LRC Program-Laboratory Methods Committee: Cholesterol and triglyceride concentrations in serum/plasma pairs . Clin Chem 1977;;23:60-63.
34 +
Prineas R, Crow R, Blackburn H. The Minnesota Code Manual: Procedures for Measurement and Classification of Electrocardiographic Findings in Clinical Trials and Population Studies . Littleton, Mass, John Wright-PSG, 1982;.

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