OBJECTIVE To assess predictors of CVD mortality among men with and without diabetes and to assess the independent effect of diabetes on the risk of CVD death. RESEARCH DESIGN AND METHODS Participants in this cohort study were screened from 1973 to 1975; vital status has been ascertained over an average of 12 yr of follow-up (range 11–13 yr). Participants were 347,978 men aged 35–57 yr, screened in 20 centers for MRFIT. The outcome measure was CVD mortality. RESULTS Among 5163 men who reported taking medication for diabetes, 1092 deaths (603 CVD deaths) occurred in an average of 12 yr of follow-up. Among 342,815 men not taking medication for diabetes, 20,867 deaths were identified, 8965 ascribed to CVD. Absolute risk of CVD death was much higher for diabetic than nondiabetic men of every age stratum, ethnic background, and risk factor level—overall three times higher, with adjustment for age, race, income, serum cholesterol level, sBP, and reported number of cigarettes/day ( P CONCLUSIONS These findings emphasize the importance of rigorous sustained intervention in people with diabetes to control blood pressure, lower serum cholesterol, and abolish cigarette smoking, and the importance of considering nutritional-hygienic approaches on a mass scale to prevent diabetes.

https://www.siditalia.it/pdf/Diabete-ed-Arterosclerosi/MRFIT_Diab_care_1993.pdf

Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial.

Background End-stage renal disease in the United States creates a large burden for both individuals and society as a whole. Efforts to prevent the condition require an understanding of modifiable risk factors. Methods We assessed the development of end-stage renal disease through 1990 in 332,544 men, 35 to 57 years of age, who were screened between 1973 and 1975 for entry into the Multiple Risk Factor Intervention Trial (MRFIT). We used data from the national registry for treated end-stage renal disease of the Health Care Financing Administration and from records on death from renal disease from the National Death Index and the Social Security Administration. Results During an average of 16 years of follow-up, 814 subjects either died of end-stage renal disease or were treated for that condition (15.6 cases per 100,000 person-years of observation). A strong, graded relation between both systolic and diastolic blood pressure and end-stage renal disease was identified, independent of associations between th...

Blood Pressure and End-Stage Renal Disease in Men

To assess the combined influence of blood pressure (BP), serum cholesterol level, and cigarette smoking on death from coronary heart disease (CHD) and to describe how these associations vary with age, data on those factors and on mortality for 316 099 men screened for the Multiple Risk Factor Intervention Trial (MRFIT) were examined. Vital sta tus of participants has been determined after an average follow-up of 12 years; 6327 deaths from CHD have been identified. Strong graded relationships between serum cho lesterol levels above 4.65 mmol/L (180 mg/dL), systolic BP above 110 mm Hg, and diastolic BP above 70 mm Hg and mortality due to CHD were evident. Smokers with serum cholesterol and systolic BP levels in the highest quintiles had CHD death rates that were approximately 20 times greater than nonsmoking men with systolic BP and cholesterol lev els in the lowest quintile. Systolic and diastolic BP, serum cholesterol level, and cigarettes per day were significant predictors of death due to CHD in all age groups. Systolic BP was a stronger predictor than diastolic BP. These results, together with the findings of clinical trials, offer strong support for intensified preventive efforts in all age groups. (Arch Intern Med. 1992;152:56-64)

Serum Cholesterol, Blood Pressure, Cigarette Smoking, and Death From Coronary Heart Disease Overall Findings and Differences by Age for 316099 White Men

Background.— With increased efforts to lower serum cholesterol levels, it is important to quantify associations between serum cholesterol level and causes of death other than coronary heart disease, for which an etiologic relationship has been established. Methods.— For an average of 12 years, 350 977 men aged 35 to 57 years who had been screened for the Multiple Risk Factor Intervention Trial were followed up following a single standardized measurement of serum cholesterol level and other coronary heart disease risk factors; 21 499 deaths were identified. Results.— A strong, positive, graded relationship was evident between serum cholesterol level measured at initial screening and death from coronary heart disease. This relationship persisted over the 12-year follow-up period. No association was noted between serum cholesterol level and stroke. The absence of an association overall was due to different relationships of serum cholesterol level with intracranial hemorrhage and nonhemorrhagic stroke. For the latter, a positive, graded association with serum cholesterol level was evident. For intracranial hemorrhage, cholesterol levels less than 4.14 mmol/L ( Conclusions.— The association of serum cholesterol with specific causes of death varies in direction, strength, gradation, and persistence. Further research on the determinants of low serum cholesterol level in populations and long-term follow-up of participants in clinical trials are necessary to assess whether inverse associations with noncardiovascular disease causes of death are consequences of noncardiovascular disease, whether serum cholesterol level and noncardiovascular disease are both consequences of other factors, or whether these associations are causal. ( Arch Intern Med . 1992;152:1490-1500)

Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group.

Objective. —To determine reasons for the 4-fold higher incidence of treated end-stage renal disease (ESRD) in African-American men compared with white men. Design. —Prospective study. Setting. —Men screened in 1973 through 1975 for entry into the Multiple Risk Factor Intervention Trial (MRFIT). Participants. —A total of 332 544 men (300 645 white, 20 222 African American, and 11 677 other ethnic groups) aged 35 to 57 years. Main Outcome Measures. —Incidence of ESRD assessed through 1990 using the Health Care Financing Administration national ESRD treatment registry and by surveillance for death from renal disease from data of the National Death Index and the Social Security Administration. Results. —Over a mean follow-up of 16 years, age-adjusted ESRD incidence was 13.90 per 100 000 person-years in white men and 44.22 per 100 000 person-years in African-American men. Higher blood pressure and lower socioeconomic status were associated with higher incidence of ESRD in both ethnic groups. With adjustment for baseline age, systolic blood pressure, number of cigarettes smoked, previous myocardial infarction, diabetes, income, and serum cholesterol level, relative risk of ESRD in African-American men compared with white men was reduced from 3.20 to 1.87 (95% confidence interval, 1.47-2.39). Both higher systolic blood pressure and lower income in African-American men as compared with white men were particularly related to this reduced relative risk. Results were similar when hypertensive ESRD was used as the outcome. Conclusion. —Both higher blood pressure and lower income are associated with a higher incidence of ESRD in both white and African-American men. Disparities in blood pressure and socioeconomic status relate importantly to the excess risk of ESRD in African-American men compared with white men.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=415597&pdfFileName=jama_277_16_029.pdf

Patricia Dischinger

Papers

Quality control aspects of blood pressure measurements in the Multiple Risk Factor Intervention Trial.

Background and organization of quality control in the Multiple Risk Factor Intervention Trial.