Am J Epidemiol. 2020 Jun 1;189(6):491-498. doi: 10.1093/aje/kwz255.
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.
多危险因素干预试验（MRFIT）的概念起源于 20 世纪中叶，旨在确定是否可以通过改变心血管疾病流行病学中确定的“危险因素”来预防心脏病发作。“MRFIT”一词可能最早出现在 1968 年国家心脏研究所向国家饮食-心脏可行性研究调查人员提交的报告中。基于他们的试点经验，他们建议单独进行饮食试验。然而，他们也意识到，当局可能会同意这种大规模和高风险的试验的原理，但不会同意实施这种试验，因此他们还提出了另一种选择：通过同时干预多个危险因素，是否可以预防冠心病；也就是说，进行多危险因素干预试验。经过多年由系列专家委员会的痛苦挣扎，国家心脏研究所选择了不进行解释性饮食试验，而是进行务实的多危险因素干预试验，该试验由研究所工作人员设计并根据合同进行操作。与此同时，一群不耐烦的研究人员在马卡尔斯卡会议上聚在一起，概述了广泛的心血管疾病预防政策，并提交了他们理想的多危险因素试验版本，称为 JUMBO。但是，由于该研究所自己的试验计划，国家心脏研究所没有剩余资金用于研究人员发起的提案。因此，这就是 MRFIT 没有开展的背景和故事。
