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.
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Author affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota (Henry Blackburn). This work was supported by the Scientific Council on Epidemiology and Prevention of the American Heart Association and the Scientific Council on Epidemiology and Prevention of the International Society and Foundation of Cardiology. Commentary on this article was incorporated from Dr. David Jacobs and Dr. Jeremiah Stamler and from members of the Working Group on Cardiovascular Disease History, based at the Mailman School of Public Health, Columbia University, New York, New York. Conflict of interest: None declared.
Thus, immediately following the 1968 Makarska deliberations, Stamler, Remington, and Taylor began work on a proposal to NIH for a multiple risk-factor trial to be carried out under a grant from the NHI. They were unaware that, at the same time, planning had been assigned to NHI staff for a similar undertaking to be operated, if eventually approved by Congress, under contracts with sundry national centers. In contrast, the investigator-initiated effort involved researchers with long experience in collaborative studies and trials. It reflected the fruits of their recent intense Makarska discussions. And it was unique in scope and factorial design and in its incredible full title: the National Cooperative Trial on Multifactorial Prevention of First Heart Attacks and Coronary Mortality in Free-Living, High-Risk, Middle-Aged American Men. The trial quickly became known by its handle, JUMBO. It was big—like Jumbo the elephant. (18, 19).
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- Coronary heart disease
- Explanatory and pragmatic trials
- Makarska Conference
- Multiple risk-factor intervention trial
PubMed: MeSH publication types
- Historical Article
- Journal Article
- Research Support, Non-U.S. Gov't