June 21, 1976

Multiple Risk Factor Intervention Trial-Reply

JAMA. 1976;235(25):2717. doi:10.1001/jama.1976.03260510011007

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In Reply.—  The communication from Dr Hertzman expresses regret that alcohol use is not a "factor for consideration in correlation with other variables of high risk for coronary heart disease" in the Multiple Risk Factor Intervention Trial.The design of the trial has emphasized the importance of intervention for high blood pressure, elevated blood cholesterol levels, and the cigarette habit because laboratory, clinical, and epidemiological investigations have clearly implicated these three as having critical significance. Intervention for these three factors in a randomized trial is, we believe, scientifically sound and operationally feasible.We recognize that there are other variables of interest that might have been incorporated into the basic design, such as exercise, alcohol use, carbohydrate intake, and salt habits. To have included these as primary targets would have complicated further an already complex trial. Moreover, we do not believe that these and other factors possibly subject to modification have