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Relationship between baseline risk factors and coronary heart disease and total mortality in the Multiple Risk Factor
Insights
Selected baseline risk factors like blood cholesterol, smoking, and blood pressure significantly predict coronary heart disease (CHD) death and total mortality in men. Intervention groups showed similar risk factor associations.
Area of Science:
- Cardiovascular epidemiology
- Preventive cardiology
- Clinical trial analysis
Background:
- The Multiple Risk Factor Intervention Trial (MRFIT) aimed to reduce coronary heart disease (CHD) mortality.
- Understanding baseline risk factors is crucial for predicting CHD and overall mortality.
Purpose of the Study:
- To investigate the association between baseline risk factors and subsequent CHD death and total mortality in MRFIT participants.
- To determine if intervention (SI) versus usual care (UC) affected these risk-mortality relationships.
Main Methods:
- Analysis of baseline risk factors including cholesterol, smoking, blood pressure, and lipoprotein levels.
- Utilized logistic regression models and risk scores (e.g., Framingham Study equation).
- Compared risk factor associations between special intervention (SI) and usual care (UC) groups.
Main Results:
- Age, diastolic blood pressure, cigarette smoking, and cholesterol levels were significant predictors of CHD mortality.
- Age, diastolic blood pressure, and cigarette smoking predicted total mortality.
- Systolic blood pressure and serum thiocyanate improved mortality prediction in specific subgroups, with intervention effects noted.
Conclusions:
- Baseline risk factors are strong predictors of CHD and total mortality.
- Intervention did not significantly alter the relationship between specific risk factor levels and mortality outcomes.
- Further research may explore smoking behavior changes' impact on risk prediction.
Abstract:
The relationship between selected baseline risk factors and subsequent coronary heart disease (CHD) death and total mortality among participants in the Multiple Risk Factor Intervention Trial (MRFIT) was studied in order to determine whether the three risk factors used to identify high-risk men for the trial were associated with CHD death; whether other risk factors measured at baseline, especially lipoprotein cholesterol levels, were associated with CHD and total mortality; and whether there were any differences between special intervention (SI) and usual care (UC) participants in the relationship of the specific levels of risk factors to CHD or total mortality. The three main risk factors (blood cholesterol, cigarette smoking, and diastolic blood pressure) and age were significantly associated with CHD mortality; age, diastolic blood pressure, and cigarette smoking were associated with total mortality. The risk score based on the multiple logistic equation developed from the Framingham Study was also strongly associated with CHD mortality. When the joint associations of selected baseline risk factors with CHD and total mortality were considered, age, diastolic blood pressure, cigarette smoking, and low- and high-density lipoprotein cholesterol were significantly associated with CHD mortality; age, cigarette smoking, and low-density lipoprotein cholesterol were positively associated with total mortality. Systolic blood pressure significantly improved the prediction of CHD mortality for SI and UC men when it was added to a regression model that included age, diastolic blood pressure, cigarettes smoked per day, body mass index, and lipoprotein levels, but improved the prediction of total mortality only for SI men. In similar analyses, serum thiocyanate improved the prediction of both CHD and total mortality for UC men. Among SI men the improved prediction gained by considering serum thiocyanate was less pronounced and not significant for CHD death. This latter finding may be due in part to the changes made in smoking behavior by SI participants during the course of the study. The estimated regression coefficients for CHD and total mortality endpoints were not significantly different between the SI and UC groups.