CORONARY ARTERY DISEASE RISK FACTOR CHANGES

本提案是一次重新提交，保留了所考虑的这些方面 大多数评审者的“长处”，并回答了 少数人。多重风险因素的伯明翰中心 干预试验(MRFIT)在1974-75年间对22,235名男性进行了筛查，以确定和 招募606名知情的随机志愿者；每个人都是最高的 15%(后来改为10%)有患冠状动脉病变的风险 动脉病变，但目前尚无病变表现。一半的人 随机队列(特殊干预)强化干预 降低胆固醇(节食；后来减肥和节食)；戒烟 吸烟(行为矫正小组会议)；以及控制 高血压(限盐，减肥，然后抗高血压 阶梯式护理常规，视需要而定)。另一个随机的一半(常规护理)有 在社区中接受正规医生的治疗，谁的选择？ 一直是干预或不干预这些风险因素。SI和 UC参与者每年都会接受检查，以记录健康状况和 风险因素水平。强化干预(SI)的结果是 令人欣慰。戒烟和戒血的预设目标 已经实现了压力控制。胆固醇显著下降 此外，尽管没有达到目前的目标水平。这些极好的变化是 部分被这些风险因素完全出乎意料的下降所抵消 参照组(UC)。这项研究建议招募1124名 原筛查未随机，并复查危险因素 所有的水平和病史；再加上其中的一半，做更多的 动脉粥样硬化相关异常的详细评估。在……里面 此外，该组织的死亡和病态事件将得到以下证实 死亡证明以及与医生、工人和/或家人的面谈； 视情况而定。初次筛查后危险因素的长期变化 (1974-1975)将与年计算的风险状况的变化相关 六年的间隔。这些更改将被记录在案，不仅限于 风险最高的群体，其中一部分是MRFIT参与者；但也有 1974-1975年的每个阶层或风险；从低于10%一直到90% 百分比加。因此，该数据成为针对MRFIT通常护理的检查 参与者的风险因素变化，加上一种评估更多的方法 客观上，风险因素的变化在近期下降中的作用 心血管发病率和死亡率。

This proposal is a resubmission that preserves that aspects considered "strengths" by the majority reviewers and addresses those points raised by the minority. The Birmingham Center of the Multiple Risk Factor Intervention Trial (MRFIT) screened 22,235 men in 1974-75, to identify and recruit 606 informed randomized volunteers; each of whom was in the highest 15 percent (later changed to 10 percent) at risk for developing coronary artery disease, but had no disease manifestations as yet. One half of the randomized cohort (SPECIAL INTERVENTION) had intensive intervention to lower cholesterol (diet; later, weight loss and diet); stop cigarette smoking (group sessions for behavior modification); and control hypertension (salt restriction, weight loss, and then anti-hypertensive stepped care routine, as needed). The other random half (USUAL CARE) has been treated by their regular physicians in the community, whose option it has been to intervene or not intervene in these risk factors. Both SI and UC participants have been examined annually, to record health status and risk factor levels. Results of intensive intervention (SI) have been gratifying. Preset goals for stopping cigarette smoking, and for blood pressure control have been achieved. Cholesterol has dropped significantly also, although not to the present goal levels. These excellent changes are offset in part by a totally unanticipated drop in these risk factors in the referred group (UC). This study proposes to recruit 1124 of those originally screened but not randomized, and to recheck the risk factor levels and medical histories in all; plus, in half of them, to do a more detailed assessment for atherosclerosis-related abnormalities. In addition, deaths and morbid events in the group will be corroborated by death certificates and interviews with physician, workers, and/or family; as appropriate. The secular changes in risk factors from initial screening (1974-1975) will be correlated with the change in calculated risk status in the six year interval. The changes will be documented not only for the highest risk group part of whom have been MRFIT participants; but also for each 1974-1975 stratum or risk; from below 10 percent all the way up to 90 percent plus. Thus, the data becomes a check against MRFIT Usual Care participants' risk factor changes, plus a method of assessing more objectively the role of risk factor change in the recently decreasing cardiovascular morbidity and mortality.