Eur Heart J. 1983 Mar;4(3):141-7.
Incidence and mortality results are presented from an international controlled trial of multifactorial prevention of coronary heart disease, involving randomization of 66 factories (49 781 men) in U.K., Belgium, Italy and Poland (Cracow). Results for Poland (Warsaw) are not yet complete. Net average reductions in risk factors (all subjects) were 1.2% for plasma cholesterol, 8.9% for daily cigarettes, 0.4% for weight, 2.0% for systolic blood pressure, and 11.1% for a combined risk estimate. Greater reductions occurred in high-risk subjects (19.4% for the combined estimate). The net overall reduction in CHD rates was 7.4% (95% confidence interval -29 to +15%) for deaths (722 cases), and 3.9% (95% confidence interval -10 to +2%) for fatal CHD + non-fatal myocardial infarction (1502 cases). Among men aged 40-49 the reduction for this end-point was 15%; at ages 50-59 there was a small net increase. All-causes deaths after an early adverse trend showed 2.7% reduction overall. There were large differences between centres, ranging from a 5% net increase in CHD for U.K. to a decrease of 24% in Belgium. In Belgium the decrease both in CHD and in all deaths was significant at the 5% level. The effect on CHD in the different centres correlated broadly with their changes in risk factors. It is concluded that reduction in major coronary risk factors in industrial populations is possible, but it depends on adequate resources; the results support the hypotheses that CHD risk in middle-aged men is reversible and that community intervention can be beneficial.
本文呈现了一项冠心病多因素预防的国际对照试验的发病率和死亡率结果，该试验涉及英国、比利时、意大利和波兰（克拉科夫）66家工厂（49781名男性）的随机分组。波兰（华沙）的结果尚未完整。所有受试者危险因素的净平均降低幅度为：血浆胆固醇1.2%，每日吸烟量8.9%，体重0.4%，收缩压2.0%，综合风险估计值11.1%。高危受试者的降低幅度更大（综合估计值为19.4%）。冠心病死亡率的总体净降低幅度为7.4%（95%置信区间为-29%至+15%）（722例），致命性冠心病加非致命性心肌梗死的净降低幅度为3.9%（95%置信区间为-10%至+2%）（1502例）。在40 - 49岁男性中，该终点的降低幅度为15%；在50 - 59岁男性中，有小幅净增加。早期出现不利趋势后的全因死亡总体降低了2.7%。各中心之间存在很大差异，从英国冠心病净增加5%到比利时降低24%不等。在比利时，冠心病和全因死亡的降低在5%水平上均具有显著性。不同中心对冠心病的影响与其危险因素的变化大致相关。得出的结论是，在工业人群中降低主要冠心病危险因素是可能的，但这取决于充足的资源；这些结果支持了中年男性冠心病风险可逆以及社区干预有益的假设。
