Multiple Risk Factor Intervention

Stamler, J., Caggaila, A. and Grandiits, G., Relation of body mass and alcohol, nutrient, fiber and caffeine intkae to blood preussre in the special intervention and usual care groups in the multiple risk factor intervention trial. Am J Clin Nutr 65(1), 338-365, 1997. 

Multiple-risk-factor intervention (treatment of dyslipidemia and hypertension, smoking cessation, antiplatelet therapy) reduces macrovascular events. 

Multiple Risk Factor Intervention Triiil Research Group. 1982. Multiple risk factor intervention trial. Risk factor changes and mortality results. JAMA 248, 1465-1477. 

The Multiple Risk Factor Intervention Trial (Dolecek, 1992) included over 12,000 men over an 8-year period. The results showed that higher ALA intakes were associated with lower risks of death due to coronary heart disease and cardiovascular disease. Furthermore, a 28% reduction in risk of stroke was associated with a 0.06% increase in the ALA content of serum phospholipids (Simon et al., 1995). Other studies have since supported the association between ALA and reduction in stroke risk (Leng et al., 1999 Vartiainen et al., 1994). Vartiainen et al. (1994) followed a Finnish population of approximately 28,000 men and women over 20 years and found that a 60% reduction in mortality from stroke was associated with increased ALA consumption. In a study involving approximately 1,100 subjects, individuals suffering a stroke had significantly lower ALA concentrations in the red blood cell (Leng et al., 1999). 

Dolecek, T.A. 1992. Epidemiological evidence of relationships between dietary polyunsaturated fatty acids and mortality in the Multiple Risk Factor Intervention Trial. Proc. Soc. Exp. Biol. Med. 200, 177-182. 

Neaton JD, Blackburn H, Jacobs D, et al. Serum cholesterol level and mortality findings for men screened in the multiple risk factor intervention trial. Arch Int Med 1992 152 1490-1500. 

Grimm RH Jr, Cohen JD, Smith WM, Falvo-Gerard L, Neaton JD. Hypertension management in the Multiple Risk Factor Intervention Trial (MRFIT). Six-year intervention results for men in special intervention and usual care groups. Arch Intern Med 1985 145(7) 1191-9. 

Ishani A,GranditsGA,Grimm RH,Svendsen KH, Collins AJ, Prineas RJ, Neaton JD Association of single measurements of dipstick proteinuria, estimated glomerular filtration rate, and hematocrit with 25-year incidence ofend-stage renal disease in the multiple risk factor intervention trial. JAm Soc Nephrol 17 1444-1452,2006. 

Baycol was indicated as an adjunct to diet to reduce elevated total-cholesterol, low-density lipoprotein cholesterol (LDL-C), apo B, and triglycerides (TG) and to increase high-density lipoprotein cholesterol (HDL-C) levels in patients with primary hypercholesterolemia and mixed dyslipidemia (Fredrickson types Ila and Ilb) when the response to dietary restriction of saturated fat and cholesterol and other nonpharmacological measures alone had been inadequate. Therapy with lipid altering drugs should bea component of multiple risk factor intervention in those patients at significantly high risk for atherosclerotic vascular disease due to hypercholesterolemia. 

Figure 26-22 Relationship between cholesterol concentration and coronary heart disease mortality expressed by yearly rate per 1000 and risk ratios (Multiple Risk Factor Intervention Trial [MRFIT] participants). (From Grundy SA1. Cholesterol and coronary heart disease A new era. JAMA i 986,256 2849-55. Copyright 1986, American Medical Association.)...

Kuller L H, Tracy RP, et al. Relation of C-reactive protein and coronary heart disease in the MRFIT nested case-control study. Multiple Risk Factor Intervention Trial. Am J Epidemiol 1996 44 537-47. 

Prineas RJ, Grandits G, Rautaharju PM et al. Long-term prognostic significance of isolated minor electrocardiographic T-wave abnormalities in middle-aged men free of clinical cardiovascular disease (The Multiple Risk Factor Intervention Trial [MRFIT]). Am J Cardiol 2002 90 1391. 

The initial step in management is to modify the major risk factors for HID—hypertension, hypercholesterolemia, and smoking— and data from the Multiple Risk Factor Intervention Trial (MRFIT) show these interventions to be useful in patients with silent ischemia. In a subset of the study population that had abnormal baseline exercise ECG responses, the special intervention group had a 57% reduction in coronary heart disease death (22.2 of 1000 versus 51.8 of 1000) and a reduction in sudden death resulting from cessation of smoking and lowering of blood pressure and cholesterol when compared with the usual-care group. 

K/DOQI Kidney Dialysis Outcomes and Quality Initiative MAP mean arterial blood pressure MDRD Modification of Diet in Renal Disease MRFIT Multiple Risk Factor Intervention Trial NHANES III Third National Health and Nutritional Examination Survey... 

Brancati FL, Whelton PK, Randall BL, et al. Risk of end-stage renal disease in diabetes mellitus a prospective cohort study of men screened for MRFIT. Multiple Risk Factor Intervention Trial. JAMA 1997 278 2069-2074. 

Stamler, J. A. Caggiula G.A. Grandits M. Kjelsberg J.A. Cutler. Relationship to blood pressure of combinations of dietary macronutrients findings of the multiple risk factor intervention trial (MRFIT). Circulation 1996, 94, 2417-2423. 

Stamler J, Vaccaro O, Neaton ID, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993 16 434-444. 

Eberly LE, Cohen ID, Prineas R, Yang L. Multiple Risk Factor Intervention Trial Research Group. Impact of incident diabetes and incident nonfatal cardiovascular disease on 18-year mortality. Diabetes Care 2003 26 848-854. 

Type-2 diabetes mellitus is known to increase dramatically the risk of cardiovascular death, as shown, among several other studies, in the large cohort of 340,000 men screened in the Multiple Risk Factor Intervention Trial 11], Useful information has also been provided by the Hypertension Optimal Treatment (HOT) study [2], with analyses comparing cardiovascular outcomes in 1,503 diabetic hypertensives and 17,230 non-diabetic hypertensives, all subjected to intense antihypertensive treatment incidences of myocardial infarction, stroke, all major cardiovascular events, cardiovascular and all-cause mortalities were much higher in diabetics than in non-diabetics with relative risk of 1.45-2.13 even after adjusting for all other baseline risk factors (Fig. 1). Calculations from a recent meta-analysis of antihypertensive treatment trials... 

Phinney, S.D., et al.. The human metabolic response to chronic ketosis without caloric restriction physical and biochemical adaptation. Metabolism, 32, 757, 1983. Stamler, J., Wentworth, D., and Neaton, J.D., Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRHT), JAMA, 256, 2823, 1986. 

MRFIT indicates Multiple Risk Factor Intervention Trial. 

Figure 7.9 The relationship between serum cholesterol and coronary heart disease mortality. From data reported by the Multiple Risk Factor Intervention Trial Research Group (1982) Journal of the American Medical Association 248 1465—1475.

Kjelsberg, M.O., Cutler, J.A., and Dolecek, T.A., Brief description of the Multiple Risk Factor Intervention Trial. Am. J. Clin. Nutr. 65, 191S-195S, 1997. 

Stamler J, Caggiula AW, Cutler JA et al. (1997) Dietary and nutritional methods and findings The Multiple Risk Factor Intervention Trial (MRFIT). American Journal of Clinical Nutrition 65(1 supplement) 183S 02S. 

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