Polypills Approach for Multiple Cardiovascular Risk Factors (PACIF)
Polypills Approach for Multiple Cardiovascular Risk Factors (PACIF) : a Multicentre, Open-label, Randomized Controlled Trial
Tutkimuksen yleiskatsaus
Tila
Tila
Ehdot
Ehdot
Interventio / Hoito
Interventio / Hoito
Yksityiskohtainen kuvaus
The overall objective of the PACIF Trial is to test a fixed-dose combination strategy for the integrated management of hypertension, dyslipidemia, and diabetes. This multicenter randomized controlled trial will evaluate whether a polypill-based approach, compared with usual care, improves cardiovascular risk factor control and reduces cardiovascular disease events among adults with multiple cardiovascular risk factors but without prior cardiovascular disease. The trial will recruit an estimated 8,252 participants aged 50 to <75 years who have hypertension, dyslipidemia, and type 2 diabetes. Participants will be randomly assigned to receive either a fixed-dose combination strategy or usual care.
In the intervention group, the study medication regimen will consist of eight prespecified fixed-dose formulations combining blood pressure-lowering, lipid-lowering, and glucose-lowering therapies. These formulations include olmesartan medoxomil/amlodipine, rosuvastatin, ezetimibe, and dapagliflozin, with indapamide included in selected formulations. Treatment will be adjusted among the prespecified fixed-dose formulations according to participants' blood pressure levels, treatment targets, tolerability, and safety. Additional open-label medications may be used according to guideline recommendations and clinical judgment if the prespecified treatment targets are not achieved with the fixed-dose combination strategy. Treatment targets are defined as blood pressure <130/80 mmHg, LDL cholesterol <1.8 mmol/L, and HbA1c <7.0%.
The primary outcome at Phase 1 is the ACC/AHA 10-year cardiovascular disease risk estimated by the PREVENT equations. In addition, changes in PREVENT-estimated 10-year ASCVD and heart failure risk, the proportions of participants achieving the prespecified blood pressure, lipid, and glycemic targets, and changes in individual cardiovascular risk factors will also be evaluated.
The primary outcome at Phase 2 is a composite cardiovascular disease outcome including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, heart failure requiring hospitalization or treatment, and coronary revascularization. Cognitive outcomes will also be assessed, with incident all-cause dementia prespecified as a major secondary outcome.
Opintotyyppi
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Ilmoittautuminen
Vaihe
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskelupaikat
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Henan
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Zhengzhou, Henan, Kiina
- Ei vielä rekrytointia
- The First Affiliated Hospital of Henan University of Chinese Medicine
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Ottaa yhteyttä:
- Xincan Liu
- Puhelinnumero: +86 13203825657
- Sähköposti: Liuxincan103@163.com
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Inner Mongolia
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Chifeng, Inner Mongolia, Kiina
- Rekrytointi
- Affiliated Hospital of Chifeng University
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Ottaa yhteyttä:
- Xuchen Han
- Puhelinnumero: +86 15504766986
- Sähköposti: hanxuchen2004@163.com
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Tongliao, Inner Mongolia, Kiina
- Ei vielä rekrytointia
- Tongliao People's Hospital
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Ottaa yhteyttä:
- Kai Zheng
- Puhelinnumero: +86 15004963990
- Sähköposti: udbmnm2012@163.com
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Jiangsu
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Kunshan, Jiangsu, Kiina
- Ei vielä rekrytointia
- Kunshan Hospital of Chinese Medicine
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Ottaa yhteyttä:
- Hengshan Shen
- Puhelinnumero: +86 13962637574
- Sähköposti: 847658065@qq.com
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Suzhou, Jiangsu, Kiina
- Ei vielä rekrytointia
- The Second Affiliated Hospital of Soochow University
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Ottaa yhteyttä:
- Jijun Shi
- Puhelinnumero: +86 18934593776
- Sähköposti: shijijun2008@126.com
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Suzhou, Jiangsu, Kiina
- Ei vielä rekrytointia
- Suzhou Wujiang District Hospital of Traditional Chinese Medicine
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Ottaa yhteyttä:
- Wangfeng Qian
- Puhelinnumero: +86 13771692578
- Sähköposti: wfss873@sina.com
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Suzhou, Jiangsu, Kiina
- Ei vielä rekrytointia
- The Fifth People's Hospital of Wujiang District
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Ottaa yhteyttä:
- Jun Li
- Puhelinnumero: +86 13913731272
- Sähköposti: lijun19801005@163.com
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Taizhou, Jiangsu, Kiina
- Ei vielä rekrytointia
- Taixing Second People's Hospital
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Ottaa yhteyttä:
- Ligong Ji
- Puhelinnumero: +86 13815979287
- Sähköposti: 420643682@qq.com
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Liaoning
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Jinzhou, Liaoning, Kiina
- Rekrytointi
- Central Hospital of Jinzhou
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Ottaa yhteyttä:
- Shuai Jiang
- Puhelinnumero: +86 13897854774
- Sähköposti: 13897854774@163.com
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Panjin, Liaoning, Kiina
- Ei vielä rekrytointia
- Panjin Central Hospital
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Ottaa yhteyttä:
- Qiong Zhang
- Puhelinnumero: +86 15504272626
- Sähköposti: yoner6789@163.com
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Shenyang, Liaoning, Kiina
- Ei vielä rekrytointia
- Shengjing Hospital of China Medical University
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Ottaa yhteyttä:
- Anhua Wu
- Puhelinnumero: +86 18900925766
- Sähköposti: ahwu@cmu.edu.cn
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Shenyang, Liaoning, Kiina, 110001
- Rekrytointi
- First Hospital of China Medical University
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Ottaa yhteyttä:
- Guozhe Sun
- Puhelinnumero: +86 15040292137
- Sähköposti: gzhsun66@163.com
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Tieling, Liaoning, Kiina
- Rekrytointi
- Tieling Central Hospital
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Ottaa yhteyttä:
- Caixia Yang
- Puhelinnumero: +86 13704109696
- Sähköposti: 2624603253@qq.com
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Tieling, Liaoning, Kiina
- Rekrytointi
- Tiemei General Hospital of Liaoning Health Industry Group
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Ottaa yhteyttä:
- Geng Wang
- Puhelinnumero: +86 15542052188
- Sähköposti: 15542052188@163.com
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Shandong
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Jinan, Shandong, Kiina
- Ei vielä rekrytointia
- Shandong Provincial Hospital Affiliated to Shandong First Medical University
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Ottaa yhteyttä:
- Xiaoming Zhou
- Puhelinnumero: +86 15168887283
- Sähköposti: sdslyy@yeah.net
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Osallistumiskriteerit
Kelpoisuusvaatimukset
Kelpoisuusvaatimukset
Opintokelpoiset iät
- Aikuinen
- Vanhempi Aikuinen
Hyväksyy terveitä vapaaehtoisia
Kuvaus
Inclusion Criteria:
- Men or women
- Age ≥50 years and <75 years
- Systolic blood pressure ≥130 mmHg
- LDL-C ≥1.8 mmol/L (70 mg/dL)
- Type 2 diabetes with HbA1c ≥6.5% and <12%
- Willing to participate and able to sign informed consent
Exclusion Criteria:
- Known secondary cause of hypertension
- Type 1 diabetes
- Pancreatic insufficiency or diabetes secondary to pancreatitis
- Triglycerides ≥5.65 mmol/L (500 mg/dL)
- History of myocardial infarction, stroke, or heart failure
- History of coronary, cerebrovascular, or peripheral arterial revascularization
- Abnormal kidney function, defined as estimated glomerular filtration rate <30 mL/min/1.73 m² or dialysis
- Abnormal liver function, defined as alanine aminotransferase or aspartate aminotransferase >3 times the upper limit of normal
- Abnormal serum potassium, defined as serum potassium >5.5 mmol/L or <3.5 mmol/L
- Contraindication to any of the components of the polypill
- Currently living with another PACIF participant
- Pregnancy, currently trying to become pregnant, or of child-bearing potential and not using birth control
- Clinical diagnosis of dementia or treatment with medications for dementia
- History of malignancy
- Life expectancy <3 years
- Currently participating in another intervention study
- Any factors judged by the clinic team to be likely to limit adherence to interventions
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Yksittäinen
Aseiden lukumäärä
Aseet ja interventiot
Osallistujaryhmä / ArmOsallistujaryhmä / Arm |
Interventio / HoitoInterventio / Hoito |
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Ei väliintuloa: Ohjausryhmä
Tavallinen hoito
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Kokeellinen: Experimental
Polypill intervention
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Participants assigned to the intervention group will receive a fixed-dose combination strategy for the integrated control of blood pressure, lipid, and glucose.
Eight prespecified fixed-dose formulations will be used, differing in antihypertensive intensity and rosuvastatin dose.
All formulations will include olmesartan medoxomil/amlodipine, rosuvastatin, ezetimibe 10 mg, and dapagliflozin 10 mg, with indapamide 2.5 mg included in selected formulations.
The olmesartan medoxomil/amlodipine dose will range from 5/1.25 mg to 20/5 mg, and the rosuvastatin dose will be either 5 mg or 10 mg.
Treatment will be selected and adjusted among the prespecified fixed-dose formulations according to participants' blood pressure levels, treatment targets, tolerability, and safety.
If the prespecified blood pressure, lipid, or glycemic targets are not achieved despite the highest fixed-dose regimen, additional open-label medications may be prescribed according to guideline recommendations.
Muut nimet:
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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10-year CVD risk
Aikaikkuna: 12 months
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Changes in 10-year CVD risk estimated by the PREVENT equations
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12 months
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Composite cardiovascular disease outcome
Aikaikkuna: 36 months
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Record the occurrence of the composite cardiovascular disease outcome, including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, heart failure requiring hospitalization or treatment, and coronary revascularization
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36 months
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Toissijaiset tulostoimenpiteet
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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10-year ASCVD risk
Aikaikkuna: 12 months
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Changes in 10-year ASCVD risk estimated by the PREVENT equations
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12 months
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10-year HF risk
Aikaikkuna: 12 months
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Changes in 10-year HF risk estimated by the PREVENT equations
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12 months
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Medication adherence
Aikaikkuna: 12 months
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Medication adherence assessed by participant self-report, pill count, or other prespecified adherence measures
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12 months
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Cost-effectiveness
Aikaikkuna: 12 months
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Data on the costs of CVD risk assessment and management will be collected for both study groups.
The cost-effectiveness analysis will estimate the incremental cost per unit reduction in estimated 10-year CVD risk in the intervention group compared with the control group.
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12 months
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Composite outcome of composite cardiovascular disease outcome or deaths
Aikaikkuna: 36 months
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Record the occurrence of composite outcome of composite cardiovascular disease outcome or deaths
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36 months
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Macrovascular outcome
Aikaikkuna: 36 months
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Record the occurrence of any of the following: stroke, myocardial infarction, heart failure requiring hospitalization or treatment, aortic dissection, any cardiovascular revascularization procedures, or cardiovascular death
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36 months
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Major coronary artery diseases
Aikaikkuna: 36 months
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Record the occurrence of any of the following: myocardial infarction, revascularization of coronary arteries, or deaths due to coronary artery diseases
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36 months
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New-onset chronic kidney disease or progression of chronic kidney disease
Aikaikkuna: 36 months
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Record the occurrence of new-onset chronic kidney disease or progression of chronic kidney disease
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36 months
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Medication adherence
Aikaikkuna: 36 months
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Medication adherence assessed by participant self-report, pill count, or other prespecified adherence measures
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36 months
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Health related quality of life
Aikaikkuna: 36 months
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Health-related quality of life will be assessed by the Five-Level Version of the EQ-5D (EQ-5D-5L).
In this questionnaire, 5 dimensions are measured in 5 items: mobility, self-care, usual activities, pain/discomfort and anxiety/depression.
A 5-point Likert scale ranging from "no problems" to "extreme problems" is used for every dimension, with higher scores reflecting more problems in a dimension.
A VAS ranging from 0 to 100 (0 = "The best health you can imagine" to 100 = "The worst health you can imagine") is applied as well, with higher scores indicating a better health state as perceived by the patient.
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36 months
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Cost-effectiveness
Aikaikkuna: 36 months
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Cost-effectiveness assessed by the incremental cost-effectiveness ratio, expressed as the incremental cost per quality-adjusted life-year gained.
Quality-adjusted life-years will be estimated from health utilities derived using the EQ-5D-5L questionnaire.
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36 months
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Major secondary endpoint: All-cause dementia
Aikaikkuna: 36 months
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Record the occurrence of all-cause dementia
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36 months
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Hierarchical composite of all-cause mortality, nonfatal cardiovascular events, and improvement in 10-year cardiovascular disease risk estimated by the PREVENT equations
Aikaikkuna: 12 months
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Hierarchical composite of all-cause mortality, nonfatal cardiovascular events, and improvement in 10-year cardiovascular disease risk estimated by the PREVENT equations
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12 months
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The proportions of participants achieving the prespecified blood pressure, LDL-C, and HbA1c targets, individually and jointly
Aikaikkuna: 12 months
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The proportions of participants achieving the prespecified targets for blood pressure (systolic blood pressure <130 mmHg and diastolic blood pressure <80 mmHg), LDL-C (<1.8 mmol/L), and HbA1c (<7.0%), individually and jointly
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12 months
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Blood pressure, LDL-C, and HbA1c
Aikaikkuna: 12 months
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Changes in systolic and diastolic blood pressure, LDL-C, and HbA1c
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12 months
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Hierarchical composite of all-cause mortality, nonfatal cardiovascular events, and improvement in 10-year cardiovascular disease risk estimated by the PREVENT equations
Aikaikkuna: 36 months
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Hierarchical composite of all-cause mortality, nonfatal cardiovascular events, and improvement in 10-year cardiovascular disease risk estimated by the PREVENT equations
|
36 months
|
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The proportions of participants achieving the prespecified blood pressure, LDL-C, and HbA1c targets, individually and jointly
Aikaikkuna: 36 months
|
The proportions of participants achieving the prespecified targets for blood pressure (systolic blood pressure <130 mmHg and diastolic blood pressure <80 mmHg), LDL-C (<1.8 mmol/L), and HbA1c (<7.0%), individually and jointly
|
36 months
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Blood pressure, LDL-C, and HbA1c
Aikaikkuna: 36 months
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Changes in systolic and diastolic blood pressure, LDL-C, and HbA1c
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36 months
|
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Myocardial infarction
Aikaikkuna: 36 months
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Record the occurrence of myocardial infarction
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36 months
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Stroke
Aikaikkuna: 36 months
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Record the occurrence of stroke
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36 months
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Ischemic stroke
Aikaikkuna: 36 months
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Record the occurrence of ischemic stroke
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36 months
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Hemorrhagic stoke
Aikaikkuna: 36 months
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Record the occurrence of hemorrhagic stroke
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36 months
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Heart failure requiring hospitalization or treatment
Aikaikkuna: 36 months
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Record the occurrence of heart failure requiring hospitalization or treatment
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36 months
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Coronary revascularization
Aikaikkuna: 36 months
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Record the occurrence of coronary revascularization
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36 months
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Cardiovascular disease death
Aikaikkuna: 36 months
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Record the occurrence of cardiovascular disease death
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36 months
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All-cause death
Aikaikkuna: 36 months
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Record the occurrence of all-cause death
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36 months
|
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Microvascular outcomes
Aikaikkuna: 36 months
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Record the occurrence of microvascular complications (e.g., diabetic kidney disease and diabetic peripheral neuropathy)
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36 months
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Mild cognitive impairment
Aikaikkuna: 36 months
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Record the occurrence of mild cognitive impairment
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36 months
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Composite outcome of dementia and mild cognitive impairment
Aikaikkuna: 36 months
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Record the occurrence of the composite outcome of dementia and mild cognitive impairment
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36 months
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Composite outcome of dementia and all-cause death
Aikaikkuna: 36 months
|
Record the occurrence of the composite outcome of dementia and all-cause death
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36 months
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Opintojen valmistuminen
Opintoihin ilmoittautumispäivät
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