scholarly journals Impact of Incident Diabetes and Incident Nonfatal Cardiovascular Disease on 18-Year Mortality: The Multiple Risk Factor Intervention Trial experience

Diabetes Care ◽  
2003 ◽  
Vol 26 (3) ◽  
pp. 848-854 ◽  
Author(s):  
L. E. Eberly ◽  
J. D. Cohen ◽  
R. Prineas ◽  
L. Yang
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Incident Diabetes ◽  
Multiple Risk Factor ◽  
Intervention Trial ◽  
Trial Experience ◽  
Multiple Risk

The National Cooperative Trial on Multifactorial Prevention of First Heart Attacks and Coronary Mortality in Free-Living, High-Risk, Middle-Aged American Men, Also Known as JUMBO: A Short Story

2019 ◽  
Vol 189 (6) ◽  
pp. 491-498 ◽  
Author(s):  
Henry Blackburn
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Multiple Risk Factor ◽  
Intervention Trial ◽  
Heart Attacks ◽  
Heart Institute ◽  
National Heart ◽  
Multiple Risk ◽  
National Cooperative

Abstract The concept of a multiple risk-factor intervention trial (MRFIT) originated in mid-20th century efforts to determine whether modifying the “risk factors” established by cardiovascular disease epidemiology would prevent heart attacks. The term “MRFIT” probably first appeared in the 1968 report to the National Heart Institute from investigators of the National Diet-Heart Feasibility Study. Based on their pilot experience, they recommended a trial of diet alone. Aware, however, that authorities might agree with the rationale but not the implementation of such a massive and risky undertaking, they also proposed an alternative: whether coronary heart disease was preventable at all by simultaneous intervention on several risk factors; that is, a multiple risk-factor intervention trial. After some years agonizing by serial expert committees, the National Heart Institute opted against an explanatory diet trial and for a pragmatic multiple risk-factor intervention, one designed by Institute staff and operated under contract. Meanwhile, an impatient community of investigators met together in the Makarska Conference, outlined a broad cardiovascular disease prevention policy, and submitted their idealized version of a multiple risk-factor trial, called JUMBO. But the National Heart Institute, because of the plan for its own trial, had no funds left for an investigator-initiated proposal. Hence, this background and story of the MRFIT that wasn’t.

A win ratio approach to the re-analysis of Multiple Risk Factor Intervention Trial

2019 ◽  
Vol 16 (6) ◽  
pp. 626-634
Author(s):  
Ales Kotalik ◽  
Anne Eaton ◽  
Qinshu Lian ◽  
Carlos Serrano ◽  
John Connett ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Usual Care ◽  
Intervention Group ◽  
Matched Pair ◽  
Multiple Risk Factor ◽  
Event Analysis ◽  
Intervention Trial ◽  
Composite Outcomes ◽  
Multiple Risk

Background: Composite outcomes, which combine multiple types of clinical events into a single outcome, are common in clinical trials. The usual analysis considers the time to first occurrence of any event in the composite. The major criticisms of such an approach are (1) this implicitly treats the outcomes as if they were of equal importance, but they often vary in terms of clinical relevance and severity, (2) study participants often experience more than one type of event, and (3) often less severe events occur before more severe ones, but the usual analysis disregards any information beyond that first event. Methods: A novel approach, referred to as the win ratio, which addresses the aforementioned criticisms of composite outcomes, is illustrated with a re-analysis of data on fatal and non-fatal cardiovascular disease time-to-event outcomes reported for the Multiple Risk Factor Intervention Trial. In this trial, 12,866 participants were randomized to a special intervention group ( n = 6428) or a usual care ( n = 6438) group. Non-fatal outcomes were ranked by risk of cardiovascular disease death up to 20 years after trial. In one approach, participants in the special intervention and usual care groups were first matched on coronary heart disease risk at baseline and time of enrollment. Each matched pair was categorized as a winner or loser depending on which one experienced a cardiovascular disease death first. If neither died of cardiovascular disease causes, they were evaluated on the most severe non-fatal outcome. This process continued for all the non-fatal outcomes. A second win ratio statistic, obtained from Cox partial likelihood, was also estimated. This statistic provides a valid estimate of the win ratio using multiple events if the marginal and conditional survivor functions of each outcome satisfy proportional hazards. Loss ratio statistics (inverse of win ratios) are compared to hazard ratios from the usual first event analysis. A larger 11-event composite was also considered. Results: For the 7-event cardiovascular disease composite, the previously reported first event analysis based on 581 events in the special intervention group and 652 events in the usual care group yielded a hazard ratio (95% confidence interval) of 0.89 (0.79–0.99), compared to 0.86 (0.77–0.97) and 0.91 (0.81–1.02) for the severity ranked estimates. Results for the 11-event composite also confirmed the findings of the first event analysis. Conclusion: The win ratio analysis was able to leverage information collected past the first experienced event and rank events by severity. The results were similar to and confirmed previously reported traditional first event analysis. The win ratio statistic is a useful adjunct to the traditional first event analysis for trials with composite outcomes.

scholarly journals Homocyst(e)ine and Risk of Cardiovascular Disease in the Multiple Risk Factor Intervention Trial

1997 ◽  
Vol 17 (10) ◽  
pp. 1947-1953 ◽  
Author(s):  
Rhobert W. Evans ◽  
B. Jessica Shaten ◽  
John D. Hempel ◽  
Jeffrey A. Cutler ◽  
Lewis H. Kuller
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Multiple Risk Factor ◽  
Intervention Trial ◽  
Multiple Risk

scholarly journals Predictors of mortality from kidney cancer in 332,547 men screened for the Multiple Risk Factor Intervention Trial

Cancer ◽  
1997 ◽  
Vol 79 (11) ◽  
pp. 2171-2177 ◽  
Author(s):  
Steven S. Coughlin ◽  
James D. Neaton ◽  
Bryan Randall ◽  
Anjana Sengupta ◽  
Keyword(s):  
Risk Factor ◽  
Kidney Cancer ◽  
Multiple Risk Factor ◽  
Intervention Trial ◽  
Predictors Of Mortality ◽  
Multiple Risk

Recruitment of participants for the Multiple Risk Factor Intervention Trial (MRFIT)

1987 ◽  
Vol 8 (4) ◽  
pp. 41-53 ◽  
Author(s):  
James D. Neaton ◽  
Richard H. Grimm ◽  
Jeffrey A. Cutler
Keyword(s):  
Risk Factor ◽  
Multiple Risk Factor ◽  
Intervention Trial ◽  
Multiple Risk
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