A Study to Evaluate the Effect of Long-term Treatment With BELVIQ (Lorcaserin HCl) on the Incidence of Major Adverse Cardiovascular Events and Conversion to Type 2 Diabetes Mellitus in Obese and Overweight Subjects With Cardiovascular Disease or Multiple Cardiovascular Risk Factors
- Conditions
- OverweightType 2 DiabetesCardiovascular DiseaseHigh Cardiovascular RiskObesity
- Interventions
- Drug: Placebo
- Registration Number
- NCT02019264
- Lead Sponsor
- Eisai Inc.
- Brief Summary
This is a multicenter, randomized, double-blind, placebo-controlled, parallel-group study in overweight and obese subjects with cardiovascular (CV) disease and/or multiple CV risk factors.
- Detailed Description
Approximately 12,000 subjects will be randomized to two treatment groups in a ratio of 1:1, stratified by the presence of established CV disease (approximately 80%) or CV risk factors without established CV disease (approximately 20%). Subjects will receive lorcaserin HCl 10 mg BID or placebo BID. The study will consist of 2 phases: Prerandomization and Randomization. The Prerandomization Phase will last up to 30 days and consist of one visit during which subjects will be screened for eligibility. The Randomization Phase will consist of two periods: Treatment and Follow-up. The Treatment Period will last for approximately 5 years with approximately 18 visits and Follow-up period is 30 (+ or - 10 days) from the end of treatment visit.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 14673
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo Placebo Placebo twice daily Lorcaserin hydrochloride (HCL)10 mg Lorcaserin hydrochloride APD356 10 mg twice daily
- Primary Outcome Measures
Name Time Method Time From Randomization to First Occurrence of Major Adverse Cardiovascular Events (MACE) at Interim Analysis Baseline up to Month 42 The MACE events involved myocardial infarction (MI), stroke, or cardiovascular (CV) death. The outcome data was assessed using Kaplan-Meier estimate and Greenwood Formula.
Time From Randomization to First Occurrence of MACE+ Baseline up to end of study (Month 56) The MACE+ events involved MI, stroke, or CV death or hospitalization for unstable angina or heart failure (HF), or any coronary revascularization. The outcome data was assessed using Kaplan-Meier estimate and Greenwood Formula.
- Secondary Outcome Measures
Name Time Method Time From Randomization to Conversion to Type 2 Diabetes Mellitus (T2DM) for Participants With Prediabetes at Baseline Baseline up to end of study (Month 56) Time from randomization to conversion to T2DM was defined as first occurrence of any component of the 2013 American Diabetes Association (ADA) Diagnostic Criteria (ADA, 2013) in participants with prediabetes at baseline. The diagnostic criteria were met if a participant had unequivocal hyperglycemia (random plasma glucose greater than or equal to (\>=) 200 milligram per deciliter (mg/dL) (11.1 millimole per liter \[mmol/L\]) with classic symptoms of hyperglycemia or hyperglycemic crisis) or any of the following criteria were observed and subsequently confirmed on repeat laboratory testing such as: glycosylated hemoglobin (HbA1c) \>=to 6.5%; fasting plasma glucose (FPG) \>=126 mg/dL (7.0 mmol/L); 2-hour plasma glucose \>=200 mg/dL (11.1 mmol/L) by an oral glucose tolerance test (OGTT). The outcome data was assessed using Kaplan-Meier estimate and Greenwood Formula.
Time From Randomization to First Occurrence of the Individual Components of MACE+ Baseline up to end of study (Month 56) The MACE+ events involved MI, stroke, or CV death or hospitalization for unstable angina or HF, or any coronary revascularization. The outcome data was assessed using Kaplan-Meier estimate and Greenwood Formula.
Time From Randomization to Event of All-cause Mortality Baseline up to end of study (Month 56) The outcome data was assessed using Kaplan-Meier estimate and Greenwood Formula.
Time From Randomization to Conversion to Normal Glucose Homeostasis in Participants With Prediabetes at Baseline Baseline up to end of study (Month 56) Normal glucose homeostasis was defined as HbA1c less than or equal to (\<=) 5.6% and FPG \< 100 mg/dL without any antidiabetic treatment. The outcome data was assessed using Kaplan-Meier estimate and Greenwood Formula.
Time From Randomization to Conversion to T2DM for Participants Without Any Type of Diabetes at Baseline Baseline up to end of study (Month 56) The outcome data was assessed using Kaplan-Meier estimate and Greenwood Formula.
Change From Baseline in HbA1c at Month 6 in Participants With T2DM at Baseline Baseline, and Month 6 Time From Randomization to Event of New Onset Renal Impairment or Worsening Existing Renal Impairment in All Participants Baseline up to end of study (Month 56) New onset/worsening of existing renal impairment was first occurrence of any events: microalbuminuria and macroalbuminuria (albumin-to-creatinine ratio \[ACR\] \>=30mcg/mg and ACR\>=300 mcg/mg in spot urine), worsening albuminuria (microalbuminuria at Baseline developed macroalbuminuria, ACR increased \>=30% from Baseline during treatment), newly developed chronic kidney disease (CKD) (eGFR \>=90 milliliter per minute per 1.73 \[mL/min/1.73\]body surface area (BSA) and without kidney damage at Baseline changed to CKD Stage 1/higher as per National Kidney Foundation \[NKF\] Guidelines \[2002\]) or worsening of CKD (CKD Stage 1/higher as per NKF Guidelines \[2002\] worsened to higher CKD stages during treatment), or doubling of serum creatinine (creatinine value at least 2 times Baseline value and \>=1.5 mg/dL during treatment.), or any of the following: end-stage renal disease, renal transplant, renal death. The outcome data was assessed using Kaplan-Meier estimate and Greenwood Formula.
Time From Randomization to Event of New Onset Renal Impairment or Worsening Existing Renal Impairment in Participants With T2DM at Baseline Baseline up to end of study (Month 56) New onset/worsening of existing renal impairment was first occurrence of any events: microalbuminuria and macroalbuminuria (ACR \>=30 mcg/mg and ACR \>=300 mcg/mg in spot urine), worsening albuminuria (microalbuminuria at baseline developed macroalbuminuria, ACR increased \>=30% from baseline during treatment), CKD (eGFR \>=90 mL/min/1.73 BSA and without kidney damage at baseline changed to CKD Stage 1/higher as per NKF Guidelines \[2002\]) or worsening of CKD (CKD Stage 1/higher as per NKF Guidelines \[2002\] worsened to higher CKD stages during treatment), or doubling of serum creatinine (creatinine value at least 2 times baseline value and \>=1.5 mg/dL during treatment.), or any of the following: end-stage renal disease, renal transplant, renal death. The outcome data was assessed using Kaplan-Meier estimate and Greenwood Formula.
Percentage of Participants With FDA-Defined Valvulopathy at Baseline Who Demonstrated Worsened FDA-Defined Valvulopathy Months 6 and 12 Time From Randomization to Event of New Onset Renal Impairment or Worsening Existing Renal Impairment in Participants With Prediabetes at Baseline Baseline up to end of study (Month 56) New onset/worsening of existing renal impairment was first occurrence of any events: microalbuminuria and macroalbuminuria (ACR \>=30mcg/mg and ACR \>=300 mcg/mg in spot urine), worsening albuminuria (microalbuminuria at baseline developed macroalbuminuria, ACR increased \>=30% from baseline during treatment), CKD (eGFR \>=90 mL/min/1.73 BSA and without kidney damage at baseline changed to CKD Stage 1/higher as per NKF Guidelines \[2002\]) or worsening of CKD (CKD Stage 1/higher as per NKF Guidelines \[2002\] worsened to higher CKD stages during treatment), or doubling of serum creatinine (creatinine value at least 2 times baseline value and \>=1.5 mg/dL during treatment.), or any of the following: end-stage renal disease, renal transplant, renal death. The outcome data was assessed using Kaplan-Meier estimate and Greenwood Formula.
Change From Baseline in Echocardiographically-Determined Pulmonary Arterial Systolic Pressure Baseline, Month 12 Time From Randomization to Event of Improvement in Renal Function in Participants With T2DM at Baseline Baseline up to end of study (Month 56) Improvement in renal function was defined as first occurrence of regression of albuminuria or regression of CKD. Regression of albuminuria was defined as when participants with macroalbuminuria at baseline developed microalbuminuria or nonalbuminuria (ACR \<30 mcg/mg in spot urine), or participants with microalbuminuria at baseline became nonalbuminuric, and ACR value decreased \>= 30% from previous assessment during treatment. Regression of CKD defined as when participants with CKD Stage 1 or higher at baseline improved to normal or lower stages by NKF guidelines (eGFR \>=90 with albuminuria at baseline improved to eGFR \>=90 without albuminuria, or eGFR 60 to 89 at baseline became eGFR \>=90 with or without albuminuria, or eGFR between 30 to 59 at baseline improved to \>60 mL/min/1.73 BSA) during treatment. The outcome data was assessed using Kaplan-Meier estimate and Greenwood Formula.
Percentage of Participants Who Met FDA-Defined Valvulopathy in Echocardiographically Determined Heart Valve Changes Months 6 and 12
Trial Locations
- Locations (478)
InterMed, PA
🇺🇸Portland, Maine, United States
Interventional Cardiac Consultants
🇺🇸Trinity, Florida, United States
Spectrum Clinical Research
🇺🇸Baltimore, Maryland, United States
Shahid Saeed MD, PC
🇺🇸Baltimore, Maryland, United States
LMC Clinical Research Inc. (Bayview)
🇨🇦Toronto, Ontario, Canada
Central Texas Clinical Research, LLC
🇺🇸Austin, Texas, United States
Clinical Research Partners
🇺🇸Richmond, Virginia, United States
Cedar-Crosse Research Center
🇺🇸Chicago, Illinois, United States
Northwestern University Feinberg School of Medicine
🇺🇸Chicago, Illinois, United States
University of Chicago
🇺🇸Chicago, Illinois, United States
Tufts Medical Center
🇺🇸Boston, Massachusetts, United States
Brigham and Women's Hospital
🇺🇸Boston, Massachusetts, United States
Seattle Women's
🇺🇸Seattle, Washington, United States
American Health Network - Thomas Moretto, MD
🇺🇸Indianapolis, Indiana, United States
Pharmax Research Clinic, Inc
🇺🇸Miami, Florida, United States
United Clinical Research Corp.
🇺🇸Miami, Florida, United States
Cardiovascular Research Center of South Florida
🇺🇸Miami, Florida, United States
South Florida Research Group LLC
🇺🇸Miami, Florida, United States
Clinical Research, Inc
🇺🇸Baltimore, Maryland, United States
Billings Clinic Research Center
🇺🇸Billings, Montana, United States
Cardiocob
🇨🇱Santiago, Chile
Indywidualna Specjalistyczna Praktyka Lekarska
🇵🇱Bezrzecze, Poland
Podlaski Osrodek Kardiologii Janusz Korecki
🇵🇱Białystok, Poland
Centrum Medyczne KERmed
🇵🇱Bydgoszcz, Poland
10 Wojskowy Szpital Kliniczny z Poliklinika SPZOZ
🇵🇱Bydgoszcz, Poland
Gordon and Leslie Diamond Health Care Centre
🇨🇦Vancouver, British Columbia, Canada
ICLE
🇲🇽Guadalajara, Jalisco, Mexico
The Partners Clinical Research Centre
🇧🇸Nassau, Bahamas
Private Medical Practice
🇲🇽Guadalajara, Jalisco, Mexico
Hospital Cardiologica Aguascalientes
🇲🇽Aguascalientes, Mexico
Hospital Regional Concepcion
🇨🇱Concepcion, Chile
Nzoz "Mada-Med"
🇵🇱Chorzów, Poland
DIABET Centrum Medyczne s. c.
🇵🇱Chrzanów, Poland
ISPL w Dziedzinie Kardiologii lek.med. Krzysztof Cymerman
🇵🇱Gdynia, Poland
NZOZ SCBK ProCordis
🇵🇱Gdynia, Poland
LANDA' Specjalistyczne Gabinety Lekarskie
🇵🇱Kraków, Poland
Medyczne Centrum Diabetologiczno Endokrynologiczno
🇵🇱Kraków, Poland
Zechowicz MEDEUSZ-PLUS
🇵🇱Olsztyn, Poland
NZOZ NEURO-KARD "Ilkowski i Partnerzy"
🇵🇱Poznań, Poland
Centrum Zdrowia Wierzchoslawice
🇵🇱Wierzchosławice, Poland
SP ZOZ w Lecznej
🇵🇱Łęczna, Poland
Gabinet Kardiologiczno-Internistyczny
🇵🇱Gdynia, Poland
Praktyka Lekarska dr n. med. Marek Bronisz
🇵🇱Inowroclaw, Poland
Piotr Mader Diabetic Clinic NZOZ PD-I
🇵🇱Kamieniec Ząbkowicki, Poland
NZOZ Eskulap SC
🇵🇱Koluszki, Poland
"CenterMed Lublin" Sp. z o.o.
🇵🇱Lublin, Poland
Nzoz Cardiamed
🇵🇱Legnica, Poland
Praktyka Lekarska Ewa Krzyzagorska
🇵🇱Poznań, Poland
SNZOZ Fundacji PROCLINICA
🇵🇱Warszawa, Poland
NZOZ ALL-MED Centrum Medyczne
🇵🇱Łódź, Poland
University of California San Diego
🇺🇸San Diego, California, United States
Clinical Research Advantage, Inc.
🇺🇸Las Vegas, Nevada, United States
The Lindner Research Center
🇺🇸Cincinnati, Ohio, United States
Clinical Research of South Nevada
🇺🇸Las Vegas, Nevada, United States
Sentral Clinical Research
🇺🇸Cincinnati, Ohio, United States
Minneapolis Heart Institute
🇺🇸Minneapolis, Minnesota, United States
Physician PrimeCare Research Institute, PLLC
🇺🇸San Antonio, Texas, United States
Connect Clinical Research Center, LCC
🇺🇸Chandler, Arizona, United States
Phoenix Heart, PLLC
🇺🇸Glendale, Arizona, United States
Advanced Cardiovascular, LLC
🇺🇸Alexander City, Alabama, United States
Diabetes and Endocrine Associates
🇺🇸La Mesa, California, United States
Arrowhead Health Centers
🇺🇸Glendale, Arizona, United States
Marin Endocrine Care & Research, Inc.
🇺🇸Greenbrae, California, United States
North Alabama Research Center, LLC
🇺🇸Athens, Alabama, United States
Torrance Clinical Research Institute, Inc.
🇺🇸Lomita, California, United States
Eclipse Clinical Research
🇺🇸Tucson, Arizona, United States
San Diego Costal Endocrinology Group AMC
🇺🇸Chula Vista, California, United States
New West Physicians, PC
🇺🇸Golden, Colorado, United States
Clinical Research Works, Bristol
🇺🇸Bristol, Connecticut, United States
George E. Platt, M.D.
🇺🇸Green Cove Springs, Florida, United States
Capitol Interventional Cardiology
🇺🇸Carmichael, California, United States
Alliance Research Centers
🇺🇸Laguna Hills, California, United States
VA Greater Los Angeles Health Care System
🇺🇸Los Angeles, California, United States
Arkansas Cardiology Clinic
🇺🇸Little Rock, Arkansas, United States
Preferred Research Partners
🇺🇸Little Rock, Arkansas, United States
Cardiovascular Research Foundation of Southern Cal
🇺🇸Beverly Hills, California, United States
Medical Group of Encino
🇺🇸Encino, California, United States
Central Cardiology
🇺🇸Bakersfield, California, United States
Coastal Multi-Specialty Research
🇺🇸Santa Ana, California, United States
Stamford Therapeutics Consortium
🇺🇸Stamford, Connecticut, United States
Harbor - UCLA Medical Center
🇺🇸Torrance, California, United States
Sharp Rees-Stealy Medical Group, Inc.
🇺🇸San Diego, California, United States
Ritchken and First MD's
🇺🇸San Diego, California, United States
Zasa Clinical Research
🇺🇸Boynton Beach, Florida, United States
Northern California Clinical Research Center
🇺🇸Redding, California, United States
Brigid Freyne MD Inc
🇺🇸Murrieta, California, United States
Ronald Chochinov, MD
🇺🇸Ventura, California, United States
Connecticut Clinical Research, LLC
🇺🇸Bridgeport, Connecticut, United States
Clinical Research of South Florida
🇺🇸Coral Gables, Florida, United States
Metabolic Clinic and Research Center
🇺🇸Los Angeles, California, United States
Chase Medical Research, LLC
🇺🇸Waterbury, Connecticut, United States
Nature Coast Clinical Research
🇺🇸Inverness, Florida, United States
Holy Cross Medical Group
🇺🇸Coral Springs, Florida, United States
Consultants in Cardiovascular Medicine
🇺🇸Elmhurst, Illinois, United States
Atlanta Diabetes Associates, Endocrinology
🇺🇸Atlanta, Georgia, United States
Cardiology Associates of Fairfield County, Norwalk
🇺🇸Norwalk, Connecticut, United States
Life Spring Research Foundation
🇺🇸Miami, Florida, United States
International Medical Research
🇺🇸Daytona Beach, Florida, United States
American Health Network of IN, LLC, Avon
🇺🇸Avon, Indiana, United States
Bay Area Cardiology
🇺🇸Brandon, Florida, United States
Community Clinical Research Center
🇺🇸Anderson, Indiana, United States
Infosphere Clinical Research
🇺🇸West Hills, California, United States
NOVA Southeastern University
🇺🇸Bradenton, Florida, United States
Alfieri Cardiology
🇺🇸Wilmington, Delaware, United States
UCH-MHS Cardiac Research
🇺🇸Colorado Springs, Colorado, United States
Meridien Research, Brooksville
🇺🇸Brooksville, Florida, United States
Connecticut Heart and Vascular Center
🇺🇸Trumbull, Connecticut, United States
Red Clay Research
🇺🇸Newark, Delaware, United States
Research Physicians Network Alliance, Pembrok
🇺🇸Pembroke Pines, Florida, United States
Medstar Union Memorial Heart Specialists
🇺🇸Baltimore, Maryland, United States
Medstar Cardiology Associates
🇺🇸Annapolis, Maryland, United States
American Health Network of IN, LLC, Franklin
🇺🇸Franklin, Indiana, United States
Atlanta Heart Specialists
🇺🇸Tucker, Georgia, United States
Brevard Cardiovascular Research Associates Inc
🇺🇸Rockledge, Florida, United States
Springfield Medical Center
🇺🇸Springfield, Florida, United States
Cardiology Associates of Northwest Indiana, P.C
🇺🇸Munster, Indiana, United States
Medical Consultants PC
🇺🇸Muncie, Indiana, United States
Advanced CardioVascular Consultants, SC
🇺🇸Rock Island, Illinois, United States
Great Lakes Medical Research
🇺🇸Westfield, New York, United States
Deaconess Clinic, Inc.
🇺🇸Evansville, Indiana, United States
Pinehurst Medical Clinic, Inc.
🇺🇸Pinehurst, North Carolina, United States
Aultman Hospital
🇺🇸Canton, Ohio, United States
Northwell Health Physician Partners Cardiology
🇺🇸Southampton, New York, United States
PMG Research of Rocky Mount
🇺🇸Rocky Mount, North Carolina, United States
Research Integrity LLC
🇺🇸Owensboro, Kentucky, United States
Premier Healthcare, LLC
🇺🇸Bloomington, Indiana, United States
Maryland Heart Associates, LLC
🇺🇸Glen Burnie, Maryland, United States
Geisinger Health Clinic
🇺🇸Danville, Pennsylvania, United States
Lycoming Internal Medicine, Inc.
🇺🇸Jersey Shore, Pennsylvania, United States
Rochester Clinical Research, Inc.
🇺🇸Rochester, New York, United States
PMG Research of Wilmington
🇺🇸Wilmington, North Carolina, United States
Long Island Heart Associates
🇺🇸Mineola, New York, United States
Burke Primary Care
🇺🇸Morganton, North Carolina, United States
Clinical Trials of America Inc. Hickory
🇺🇸Hickory, North Carolina, United States
Clinical Research Associates of Central PA, LLC
🇺🇸Altoona, Pennsylvania, United States
Doylestown Health Cardiology a Division of Doylestown Health
🇺🇸Doylestown, Pennsylvania, United States
Partners in Clinical Research
🇺🇸Cumberland, Rhode Island, United States
Piedmont Healthcare
🇺🇸Statesville, North Carolina, United States
DiGiovanna Institute for Medical Education
🇺🇸North Massapequa, New York, United States
Nisus Research at McLaren Northern Michigan Hospital
🇺🇸Petoskey, Michigan, United States
Pottstown Medical Specialists, Inc. (PMSI)
🇺🇸Pottstown, Pennsylvania, United States
Berkley Hills Clinicals
🇺🇸Johnstown, Pennsylvania, United States
Kernodle Clinic
🇺🇸Burlington, North Carolina, United States
Community Health Care
🇺🇸Massillon, Ohio, United States
Green & Seidner Family Practice Associates
🇺🇸Lansdale, Pennsylvania, United States
Capital Area Research, LLC
🇺🇸Camp Hill, Pennsylvania, United States
Adriana Pop-Moody MD Clinic, PA
🇺🇸Corpus Christi, Texas, United States
Clinical Trials of America, Inc.
🇺🇸Lenoir, North Carolina, United States
Peters Medical Research
🇺🇸High Point, North Carolina, United States
Comprehensive Cardiology Consultants
🇺🇸Langhorne, Pennsylvania, United States
Clinical Trials of America Inc.
🇺🇸Cary, North Carolina, United States
Bland Clinic, PA
🇺🇸Greensboro, North Carolina, United States
Wellmont CVA Heart Institute
🇺🇸Kingsport, Tennessee, United States
Altoona Center for Clinical Research
🇺🇸Duncansville, Pennsylvania, United States
WR-ClinSearch, LLC
🇺🇸Chattanooga, Tennessee, United States
Kore Cardiovascular Research
🇺🇸Jackson, Tennessee, United States
Metrolina Internal Medicine
🇺🇸Charlotte, North Carolina, United States
Brown Clinic, PLLP
🇺🇸Watertown, South Dakota, United States
Awasty Research Network, LLC
🇺🇸Marion, Ohio, United States
Sanford Cardiology
🇺🇸Sanford, North Carolina, United States
Lillestol Research LLC
🇺🇸Fargo, North Dakota, United States
Joseph Lamantia, DO
🇺🇸Johnstown, Pennsylvania, United States
Capital Area Research LLC
🇺🇸Newport, Pennsylvania, United States
The Jackson Clinic, PA
🇺🇸Jackson, Tennessee, United States
Geisinger Health System
🇺🇸Danville, Pennsylvania, United States
Texas Diabetes
🇺🇸Round Rock, Texas, United States
Fiona Stanley Hospital, Cardiology Research Department,CDO11
🇦🇺Murdoch, Western Australia, Australia
Research Institute of Dallas
🇺🇸Dallas, Texas, United States
West Houston Area Clinical Trial Consultants, LLC
🇺🇸Houston, Texas, United States
Alexandria Clinical Research, LLC
🇺🇸Alexandria, Virginia, United States
Manassas Clinical Research Center
🇺🇸Manassas, Virginia, United States
Saul Vizel Professional Medicine Corporation, Vizel Cardiac Research
🇨🇦Cambridge, Ontario, Canada
Chattanooga Research and Medicine (CHARM)
🇺🇸Chattanooga, Tennessee, United States
Texas Health Physicians Group, Dallas
🇺🇸Dallas, Texas, United States
Endocrine and Psychiatry Center
🇺🇸Houston, Texas, United States
Radiant Research San Antonio
🇺🇸San Antonio, Texas, United States
INOVA Health Care Services
🇺🇸Manassas, Virginia, United States
Medical Clinic of North Texas
🇺🇸Plano, Texas, United States
Clinical Investigations of Texas, LLC
🇺🇸Plano, Texas, United States
Bay Area Total Health Medical Group
🇺🇸Webster, Texas, United States
Texas Cardiology Associates of Houston
🇺🇸Kingwood, Texas, United States
Martin Diagnostic Clinic
🇺🇸Tomball, Texas, United States
Advanced Research Institute
🇺🇸Ogden, Utah, United States
LMC Diabetes & Endocrinoly
🇨🇦Markham, Ontario, Canada
Angiocardiac Care of Texas PA
🇺🇸Houston, Texas, United States
Oxford Clinical Research, LLC
🇺🇸Houston, Texas, United States
Seven Corners Medical Research Center
🇺🇸Falls Church, Virginia, United States
Joanne F. Liutkus Medicine Professional Corp.
🇨🇦Cambridge, Ontario, Canada
San Gabriel Clinical Research, LLC
🇺🇸Georgetown, Texas, United States
Permian Research Foundation
🇺🇸Odessa, Texas, United States
Ballarat Health Services
🇦🇺Ballarat, Victoria, Australia
LMC Diabetes & Endocrinology - Brampton
🇨🇦Brampton, Ontario, Canada
University of Ottawa Heart Institute
🇨🇦Ottawa, Ontario, Canada
Jalil Aziz Khan M.D., P.A.
🇺🇸Lewisville, Texas, United States
Washington Center for Weight Management and Resear
🇺🇸Arlington, Virginia, United States
Joondalup Cardiovascular Trials Foundation Inc
🇦🇺Joondalup, Western Australia, Australia
Aviva Clinical Trial Group In.
🇨🇦Burlington, Ontario, Canada
Cardiology Clinic of San Antonio
🇺🇸San Antonio, Texas, United States
Selma Medical Associates
🇺🇸Winchester, Virginia, United States
Biomedica Research Group
🇨🇱Providencia, Santiago, Chile
Odilon Alvarado, M.D.
🇺🇸Fort Worth, Texas, United States
Avenue Cardiovascular Centre
🇦🇺Saint Kilda East, Victoria, Australia
South Australian Medical Research Inst, Centre for Clinical Research
🇦🇺Adelaide, Australia
Nova Scotia Health Authority /QEII Health Sciences Centre
🇨🇦Halifax, Nova Scotia, Canada
Illawarra Shoalhaven Local Health District, Clinical Trial and Research Unit
🇦🇺Wollongong, New South Wales, Australia
Wollongong Hospital
🇦🇺Wollongong, New South Wales, Australia
Geelong Cardiology Research Unit, Barwon Health
🇦🇺Geelong, Victoria, Australia
North Shore Hospital-Cardiology Research
🇳🇿Milford, Auckland, New Zealand
Tauranga Hospital
🇳🇿Tauranga, New Zealand
Austin Health - Heidelberg Repatriation Hospital, Department of Medicine, Boronia Centre
🇦🇺Heidelberg Heights, Victoria, Australia
LMC Diabetes & Endocrinology (Etobicoke)
🇨🇦Etobicoke, Ontario, Canada
Sociedad Medica Cardiologica El Llano
🇨🇱San Miguel, Santiago, Chile
NZOZ "Eskulap"
🇵🇱Biala Rawska, Poland
LMC Diabetes & Endocrinology (Thornhill)
🇨🇦Thornhill, Ontario, Canada
North Shore Hospital - Diabetes Clinic
🇳🇿Takapuna, Auckland, New Zealand
Christchurch Hospital, Lipids
🇳🇿Christchurch, Canterbury, New Zealand
Hutt Hospital, Cardiology Dept
🇳🇿Lower Hutt, Wellington, New Zealand
Dr. Dinkar Shukla Professional Medicine Corporation
🇨🇦Sudbury, Ontario, Canada
Ccbr Cecim
🇨🇱Santiago, Chile
CECMI Ltda.
🇨🇱Temuco, Chile
Dunedin Hospital
🇳🇿Dunedin, Otago, New Zealand
Auckland City Hospital
🇳🇿Auckland, New Zealand
Christchurch Hospital, Cardiology Research
🇳🇿Christchurch, Canterbury, New Zealand
Centro de Estudios Clinicos y Especialidades Medicas S.C.
🇲🇽Monterrey, Nuevo Leon, Mexico
Taranaki Base Hospital
🇳🇿New Plymouth, Taranaki, New Zealand
Middlemore Hospital
🇳🇿Papatoetoe, Auckland, New Zealand
Indywidualna Praktyka Lekarska
🇵🇱Mrągowo, Poland
Specjalistyczna Przychodnia Lekarska MEDIKARD (SPL Medikard)
🇵🇱Płock, Poland
Specjalistyczny Gabinet Lekarski
🇵🇱Tarnów, Poland
Praktyka Lekarska Pawlowicz Lidia
🇵🇱Toruń, Poland
Centrum Medyczne AMED
🇵🇱Warszawa, Poland
Centrum Badawcze Wspolczesnej Terapii
🇵🇱Warszawa, Poland
Regionalna Poradnia Diabetologiczna
🇵🇱Wroclaw, Poland
Specjalistyczne Gabinety Lekarskie "Medicor PLUS"
🇵🇱Włocławek, Poland
Integris Cardiovascular Physicians LLC
🇺🇸Oklahoma City, Oklahoma, United States
Memorial Clinical Research
🇺🇸Oklahoma City, Oklahoma, United States
South Oklahoma Heart Research, LLC
🇺🇸Oklahoma City, Oklahoma, United States
Cardiology Wellness Center
🇺🇸Nashville, Tennessee, United States
Jean Brown Research
🇺🇸Salt Lake City, Utah, United States
UAB Medical Center
🇺🇸Birmingham, Alabama, United States
Creekside Endocrine Associates PC
🇺🇸Denver, Colorado, United States
McMaster University
🇨🇦Brampton, Ontario, Canada
Cambridge Cardiac Care Centre
🇨🇦Cambridge, Ontario, Canada
Wharton Medical Clinic Clinical Trials Group Inc.
🇨🇦Hamilton, Ontario, Canada
LMC Clinical Research Inc. (Oakville)
🇨🇦Oakville, Ontario, Canada
Dr. Cha
🇨🇦Oshawa, Ontario, Canada
Kawartha Cardiology Clinical Trials
🇨🇦Peterborough, Ontario, Canada
Dr Roger Labonte Professional Medicine Corp
🇨🇦Sudbury, Ontario, Canada
JJ DIG Research Ltd.
🇨🇦Toronto, Ontario, Canada
Keele Medical Place
🇨🇦Toronto, Ontario, Canada
St Michael's Hospital Health Centre
🇨🇦Toronto, Ontario, Canada
ViaCar Recherche Clinique
🇨🇦Brossard, Quebec, Canada
Q&T Research Outaouais Inc.
🇨🇦Gatineau, Quebec, Canada
ViaCar Recherche Clinique Inc.
🇨🇦St-Lambert, Quebec, Canada
Manna Research Inc
🇨🇦Levis, Quebec, Canada
Clinique Sante Cardio MC
🇨🇦Montreal, Quebec, Canada
Universitaire de Cardiologie et de Pneumologie de Quebec
🇨🇦Quebec City, Quebec, Canada
Centre hospitalier régional de Lanaudière
🇨🇦Saint-Charles-Borromee, Quebec, Canada
Recherche Clinique London
🇨🇦Sherbrooke, Quebec, Canada
CardioVasc HR, Inc.
🇨🇦St Jean sur Richelieu, Quebec, Canada
LMC Clinical Research Inc. (Montreal)
🇨🇦Ville Saint-Laurent, Quebec, Canada
Mobile Heart Specialists, PC
🇺🇸Mobile, Alabama, United States
Oklahoma Heart Institute
🇺🇸Tulsa, Oklahoma, United States
Long Island Gastrointestinal Research Group LLP
🇺🇸Great Neck, New York, United States
Hudson Valley Heart Center
🇺🇸Poughkeepsie, New York, United States
HeartCare Partners Clinical Research Unit
🇦🇺Milton, Queensland, Australia
Hawkes Bay Regional Hospital
🇳🇿Hastings, New Zealand
Nelson Hospital, Cardiology Department
🇳🇿Nelson, New Zealand
Lakeland Clinical Trials, Rotorua
🇳🇿Rotorua, New Zealand
PMG Research of Salisbury
🇺🇸Salisbury, North Carolina, United States
Diabetes & Endocrinology Consultants
🇺🇸Morehead City, North Carolina, United States
Long Beach Center for Clinical Research
🇺🇸Long Beach, California, United States
Beverly Hills Cardiology
🇺🇸Los Angeles, California, United States
Clinical Interventions Research Institute
🇺🇸Mission Viejo, California, United States
Valley Clinical Trials Inc
🇺🇸Northridge, California, United States
Carr Cardiology
🇺🇸Oceanside, California, United States
West Coast Research LLC
🇺🇸San Ramon, California, United States
Meridien Research
🇺🇸Lakeland, Florida, United States
Asclepius Medical Research
🇺🇸Doral, Florida, United States
Cardiology Research Associates
🇺🇸Daytona Beach, Florida, United States
Integrative Research Associates, Inc.
🇺🇸Fort Lauderdale, Florida, United States
University of Florida- Jacksonville
🇺🇸Jacksonville, Florida, United States
Eastern Research, Inc.
🇺🇸Hialeah, Florida, United States
Larry K. Levinson, D.O., P.A.
🇺🇸Hollywood, Florida, United States
Jacksonville Center for Clinical Research
🇺🇸Jacksonville, Florida, United States
Westside Center for Clinical Research
🇺🇸Jacksonville, Florida, United States
Ocala Research Institute, Inc
🇺🇸Ocala, Florida, United States
Oviedo Medical Research
🇺🇸Oviedo, Florida, United States
Cardiology Consultants
🇺🇸Pensacola, Florida, United States
Charlotte Heart Group Research Center
🇺🇸Port Charlotte, Florida, United States
Bayfront Health St. Petersburg, Research
🇺🇸Saint Petersburg, Florida, United States
Clinical Research of Central Florida
🇺🇸Winter Haven, Florida, United States
Professional Health Care of Pinellas, INC
🇺🇸Saint Petersburg, Florida, United States
Lovelace Scientific Research
🇺🇸Venice, Florida, United States
Advanced Clinical Research Group
🇺🇸Stuart, Florida, United States
Indian River Medical Center-Cardiology
🇺🇸Vero Beach, Florida, United States
Detweiler Family Medicine and Associates PC
🇺🇸Lansdale, Pennsylvania, United States
Endocrine Metabolic Associates
🇺🇸Philadelphia, Pennsylvania, United States
Geisinger Clinic
🇺🇸Scranton, Pennsylvania, United States
Central Maine Medical Center
🇺🇸Auburn, Maine, United States
New Market Cardiology Research Group
🇨🇦Newmarket, Ontario, Canada
Wake Research Associates, LLC
🇺🇸Raleigh, North Carolina, United States
LMC Clinical Research Inc. (Calgary)
🇨🇦Calgary, Alberta, Canada
Dr. Michael Heffernan
🇨🇦Oakville, Ontario, Canada
M & O Clinical Research, LLC
🇺🇸Fort Lauderdale, Florida, United States
Coastal Clinical Research, Inc.
🇺🇸Mobile, Alabama, United States
Clinical Research Alliance
🇺🇸Alhambra, California, United States
NEA Baptist Clinic
🇺🇸Jonesboro, Arkansas, United States
Alaska Heart Institute
🇺🇸Anchorage, Alaska, United States
John Muir Physician Network Clinical Research Cent
🇺🇸Concord, California, United States
Del Rosario Medical Clinic, Inc.
🇺🇸Huntington Park, California, United States
California Heart Specialists
🇺🇸Huntington Beach, California, United States
Westlake Medical Research
🇺🇸Thousand Oaks, California, United States
University of Colorado Health
🇺🇸Loveland, Colorado, United States
Ventura Cardiology Consultants
🇺🇸Ventura, California, United States
Cardiology Associates of Fairfield County, P.C.
🇺🇸Trumbull, Connecticut, United States
Aventura Heart Center
🇺🇸Aventura, Florida, United States
Clearwater Cardiovascular and Interventional Cons.
🇺🇸Safety Harbor, Florida, United States
Fleming Island Center for Clinical Research
🇺🇸Fleming Island, Florida, United States
Pasco Cardiology Center
🇺🇸Hudson, Florida, United States
Primary Care Associates
🇺🇸Fort Myers, Florida, United States
Southwest Florida Research
🇺🇸Naples, Florida, United States
Research Physicians Network Alliance
🇺🇸Hollywood, Florida, United States
South Florida Research Solutions
🇺🇸Pembroke Pines, Florida, United States
Progressive Medical Research
🇺🇸Port Orange, Florida, United States
Intercoastal Medical Group
🇺🇸Sarasota, Florida, United States
St Johns Center for Clinical Research
🇺🇸Ponte Vedra, Florida, United States
Columbia Primary Care, LLC d/b/a Heart and Health Institute
🇺🇸Plantation, Florida, United States
Meridien Research - St. Petersburg
🇺🇸Saint Petersburg, Florida, United States
Metabolic Research Institute
🇺🇸West Palm Beach, Florida, United States
Cleveland Clinic Foundation
🇺🇸West Palm Beach, Florida, United States
Urban Family Practice Associates/Clinical Research Advantage
🇺🇸Marietta, Georgia, United States
Endocrine Research Solutions, Inc.
🇺🇸Roswell, Georgia, United States
Herman Clinical Research LLC
🇺🇸Suwanee, Georgia, United States
Rockdale Medical-Research Associates
🇺🇸Conyers, Georgia, United States
Northwest Heart Clinical Research, LLC
🇺🇸Arlington Heights, Illinois, United States
Clinical Investigation Specialists, Inc. in Gurnee
🇺🇸Gurnee, Illinois, United States
American Health Network of IN, LLC
🇺🇸Muncie, Indiana, United States
American Health Network of IN, LLC, Greenfield
🇺🇸Greenfield, Indiana, United States
The University of Iowa, College of Public Health
🇺🇸Iowa City, Iowa, United States
Professional Research Network of Kansas, LLC
🇺🇸Wichita, Kansas, United States
Acadia Clinical Research, LLC
🇺🇸Bangor, Maine, United States
Eastern Maine Medical Center Northeast Cardiology Associates
🇺🇸Bangor, Maine, United States
Chesapeake Cardiovascular Associates, GBMC
🇺🇸Baltimore, Maryland, United States
Southern Maine Health Care/Maine Medical Center Research Ins
🇺🇸Biddeford, Maine, United States
Medstar Union Memorial Hospital
🇺🇸Baltimore, Maryland, United States
Overlea Personal Physicians
🇺🇸Towson, Maryland, United States
Lutherville Personal Physicians
🇺🇸Towson, Maryland, United States
MedStar Health Research Institute
🇺🇸Hyattsville, Maryland, United States
Klein & Associates, MD, PA
🇺🇸Hagerstown, Maryland, United States
Endocrine & Metabolic Consultants
🇺🇸Rockville, Maryland, United States
MD Medical Research
🇺🇸Oxon Hill, Maryland, United States
MGH Weight Center
🇺🇸Boston, Massachusetts, United States
ActivMed Practices
🇺🇸Methuen, Massachusetts, United States
Pentucket Medical Associates
🇺🇸Haverhill, Massachusetts, United States
New England Center for Clinical Research, IMCA
🇺🇸Fall River, Massachusetts, United States
Partners Community Physicians Organization
🇺🇸Needham, Massachusetts, United States
Cadillac Clinical Research, LLC
🇺🇸Cadillac, Michigan, United States
Westside Family Medical Center, PC
🇺🇸Kalamazoo, Michigan, United States
Endeavor Medical Research PLC
🇺🇸Alpena, Michigan, United States
Cardiology Consultants of East Michigan
🇺🇸Lapeer, Michigan, United States
Marquette General Heart and Vascular Institute
🇺🇸Marquette, Michigan, United States
Michigan CardioVascular Institute
🇺🇸Saginaw, Michigan, United States
American Center for Clinical Trials
🇺🇸Southfield, Michigan, United States
Saint Joseph Mercy Oakland Hospital
🇺🇸Pontiac, Michigan, United States
Remedica LLC
🇺🇸Rochester, Michigan, United States
MidMichigan Medical Center
🇺🇸Midland, Michigan, United States
Medical Research Associates, Inc.
🇺🇸Traverse City, Michigan, United States
Michigan Heart
🇺🇸Ypsilanti, Michigan, United States
Minneapolis Heart Institute Foundation
🇺🇸Baxter, Minnesota, United States
Essentia Institute of Rural Health
🇺🇸Duluth, Minnesota, United States
MNCOME Clinic
🇺🇸Eagan, Minnesota, United States
Radiant Research, Inc.
🇺🇸Greer, South Carolina, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Diabetes & Endocrinology Specialists, Inc.
🇺🇸Chesterfield, Missouri, United States
Cardiology Associates Research, LLC
🇺🇸Tupelo, Mississippi, United States
Coast Cardiovascular Consultants PLLC
🇺🇸Gulfport, Mississippi, United States
BodyAesthetic Research Center
🇺🇸Washington, Missouri, United States
Montana Health Research Institute, Inc.
🇺🇸Billings, Montana, United States
Internal Medical Associates of Grand Island, PC
🇺🇸Grand Island, Nebraska, United States
Glacier View Cardiology PC
🇺🇸Kalispell, Montana, United States
Clinical Research Advantage / Rita Chuang, M.D.
🇺🇸Henderson, Nevada, United States
Medicor Cardiology, PA
🇺🇸Bridgewater, New Jersey, United States
UmiMed Center LLC
🇺🇸East Brunswick, New Jersey, United States
Advanced Heart Care
🇺🇸Bridgewater, New Jersey, United States
Cardiovascular Associates of the Delaware Valley
🇺🇸Elmer, New Jersey, United States
Advocare Heights Primary Care
🇺🇸Haddon Heights, New Jersey, United States
Cardiovascular Associates of the Delaware Valley P
🇺🇸Haddon Heights, New Jersey, United States
Rutgers New Jersey Medical School
🇺🇸Mine Hill, New Jersey, United States
United Medical Associates, PC
🇺🇸Binghamton, New York, United States
NJ Heart
🇺🇸Linden, New Jersey, United States
Cardiovascular Associates Delaware Valley Sewell
🇺🇸Sewell, New Jersey, United States
Cardio Metabolic Institute
🇺🇸Somerset, New Jersey, United States
New Mexico Heart Institute, PA
🇺🇸Albuquerque, New Mexico, United States
Capital Cardiology Associates
🇺🇸Troy, New York, United States
Regional Clinical Research, Inc.
🇺🇸Endwell, New York, United States
Albany College of Medicine, Division of Endocrinology
🇺🇸Albany, New York, United States
Buffalo Heart Group
🇺🇸Buffalo, New York, United States
PMG Research of Charlotte, LLC
🇺🇸Charlotte, North Carolina, United States
Weill Cornell Medical College
🇺🇸New York, New York, United States
North Shore Diabetes and Endocrine Associates
🇺🇸New Hyde Park, New York, United States
Vital Prospects Clinical Research Institute PC
🇺🇸Tulsa, Oklahoma, United States
Blair Medical Associates
🇺🇸Altoona, Pennsylvania, United States
Liberty Family Practice
🇺🇸Erie, Pennsylvania, United States
Endocrine Clinical Research LLC
🇺🇸Feasterville, Pennsylvania, United States
Ilumina Clinical Associates, Johnstown
🇺🇸Johnstown, Pennsylvania, United States
The Clinical Trial Center, LLC
🇺🇸Jenkintown, Pennsylvania, United States
Palmetto Research Center, LLC
🇺🇸Spartanburg, South Carolina, United States
PMG Research of Bristol, LLC
🇺🇸Bristol, Tennessee, United States
The Endocrine Clinic
🇺🇸Memphis, Tennessee, United States
Holston Medical Group
🇺🇸Kingsport, Tennessee, United States
Texas Health Physicians Group
🇺🇸Irving, Texas, United States
Baylor Research Institute
🇺🇸Dallas, Texas, United States
Texas Health Physicians Group Fort Worth
🇺🇸Fort Worth, Texas, United States
Tand R Clinic, PA
🇺🇸Fort Worth, Texas, United States
Midland Clinical Research Center
🇺🇸Midland, Texas, United States
Cardiovascular Associates of East Texas
🇺🇸Tyler, Texas, United States
Virginia Heart
🇺🇸Falls Church, Virginia, United States
Burke Internal Medicine and Research
🇺🇸Manassas, Virginia, United States
Cardiology Consultants of Danville, Inc.
🇺🇸Danville, Virginia, United States
Danville Internal Medicine, Inc
🇺🇸Danville, Virginia, United States
Clinical Research Associates of Tidewater
🇺🇸Norfolk, Virginia, United States
Health Research of Hampton Roads - Norfolk, Inc.
🇺🇸Norfolk, Virginia, United States
Wenatchee Valley Hospital & Clinics
🇺🇸Wenatchee, Washington, United States
Universal Research Group
🇺🇸Tacoma, Washington, United States
Rowan Research Inc.
🇺🇸Spokane, Washington, United States
MultiCare Research Institute
🇺🇸Tacoma, Washington, United States
Larry D. Stonesifer, MD, Inc PS
🇺🇸Federal Way, Washington, United States
Aspirus Research Institute
🇺🇸Wausau, Wisconsin, United States
Cardiology Associates of Bellin Health
🇺🇸Green Bay, Wisconsin, United States
Marshfield Clinic
🇺🇸Marshfield, Wisconsin, United States
Coffs Harbour Health Campus
🇦🇺Coffs Harbour, New South Wales, Australia
Clinical Investigation Specialists, Inc.
🇺🇸Kenosha, Wisconsin, United States
Liverpool Hospital
🇦🇺Liverpool, New South Wales, Australia
Meriter hospital Inc., DBA: UnityPoint Health-Meriter Heart
🇺🇸Madison, Wisconsin, United States
Prevea Clinic, Inc
🇺🇸Green Bay, Wisconsin, United States
Gosford Hospital, Cardiology Clinical Trials
🇦🇺Gosford, New South Wales, Australia
Royal Brisbane and Women's Hospital, Endocrinology Department
🇦🇺Herston, Queensland, Australia
Princess Alexandra Hospital, Cardiology Research Department
🇦🇺Brisbane, Queensland, Australia
Core Research Group
🇦🇺Brisbane, Queensland, Australia
Gold Coast Hospital, Cardiovascular Research Centre
🇦🇺Southport, Queensland, Australia
Adelaide Medical Research
🇦🇺Ashford, South Australia, Australia
AusTrials Pty Ltd
🇦🇺Sherwood, Queensland, Australia
Heart and Vascular Institute
🇦🇺Fullarton, South Australia, Australia
New Royal Adelaide Hospital, Cardiology Department
🇦🇺Adelaide, South Australia, Australia
Lyell McEwin Hospital, Department of Cardiology
🇦🇺Elizabeth Vale, South Australia, Australia
The Queen Elizabeth Hospital
🇦🇺Woodville South, South Australia, Australia
Cardiolink ClinTrials S.C.
🇲🇽Monterrey, Nuevo Leon, Mexico
Ewa Mirek-Bryniarska Specjalistyczna Praktyka Lekarska
🇵🇱Kraków, Poland
Lecznice Citomed Sp. z o.o.
🇵🇱Toruń, Poland
Central Arkansas Veterans Healthcare System
🇺🇸Little Rock, Arkansas, United States
Bridgeport Hospital
🇺🇸Bridgeport, Connecticut, United States
Servicios Medicos Godoy Ltda.
🇨🇱Santiago, Chile
Centro Investigacion Clinica del Sur
🇨🇱Temuco, Chile
IMED Clin Trials
🇲🇽Monterrey, Nuevo Leon, Mexico
Hospital de Angeles Xalapa
🇲🇽Xalapa, Veracruz, Mexico
Fundacion Cardiovascular de Aguascalientes
🇲🇽Aguascalientes, Mexico
Mentrials S.A.de C.V.
🇲🇽Distrito Federal, Mexico
Meridien Research - Tampa
🇺🇸Tampa, Florida, United States
Stedman Clinical Trials
🇺🇸Tampa, Florida, United States
Healthpoint Medical Group, Inc
🇺🇸Tampa, Florida, United States
L-MARC Research Center
🇺🇸Louisville, Kentucky, United States
Norton Heart Specialists
🇺🇸Louisville, Kentucky, United States
PMG Research of Winston-Salem, LLC
🇺🇸Winston-Salem, North Carolina, United States
Florida Research Network, LLC
🇺🇸Gainesville, Florida, United States
James J. Peters VA Medical Center, Bronx, NY
🇺🇸Bronx, New York, United States
Texas Diabetes & Endocrinology
🇺🇸Austin, Texas, United States
Virginia Cardiovascular Specialists
🇺🇸Richmond, Virginia, United States
National Clinical Research-Richmond, Inc
🇺🇸Richmond, Virginia, United States
Saint Josephs Health Care London
🇨🇦London, Ontario, Canada
Research Associates of Jackson
🇺🇸Jackson, Tennessee, United States
Delaware Research Group, LLC
🇺🇸Delaware, Ohio, United States
Apex Medical Research Inc.
🇺🇸Springfield, Ohio, United States
Mountain View Clinical Research
🇺🇸Greer, South Carolina, United States
La Mesa Cardiac Center
🇺🇸La Mesa, California, United States
Palm Beach Gardens Research Center
🇺🇸Palm Beach Gardens, Florida, United States
Cardiology Partners Clinical Research Institute
🇺🇸Wellington, Florida, United States
JBN Medical Diagnostic Services Inc.
🇨🇦Burlington, Ontario, Canada