Sudden death in men with increased risk of myocardial infarction. The MRFIT Programme.

The Multiple Risk Factor Intervention Trial (MRFIT) was a randomised clinical trial of the preventability of fatal first heart attacks among middle-aged men at high risk of coronary heart disease (CHD). After screening 361,662 men aged 35 to 57 years, 12,866 men currently free of CHD at the upper end of the risk spectrum on the basis of their levels of serum cholesterol, diastolic blood pressure and cigarette smoking were randomised either to 'special intervention' (SI) or to 'usual care' (UC). Those SI men with a sustained diastolic blood pressure greater than or equal to 90mm Hg (following attempted weight loss, if indicated) received pharmacological treatment in the form of a protocol of 'stepped care'. UC men were referred to their usual source of medical care. At the termination of the study - after 6 to 8 years of intervention - no significant differences in overall deaths from CHD or from all causes were observed between the SI and UC groups. However, among the subgroup of individuals who had both a diastolic blood pressure greater than or equal to 90mm Hg and abnormalities of the resting electrocardiogram at baseline there was an excess of deaths from CHD in the SI group compared with the UC group (36 vs 21), and most of the excess deaths were sudden (20 vs 8).