Cardiovascular Inflammation Reduction Trial
- Registration Number
- NCT01594333
- Lead Sponsor
- Brigham and Women's Hospital
- Brief Summary
The Cardiovascular Inflammation Reduction Trial (CIRT) is a randomized clinical trial investigating whether taking low-dose methotrexate reduces heart attacks, strokes, or death in people with type 2 diabetes or metabolic syndrome that have had a heart attack or multiple coronary blockages. This trial is funded by the National Heart, Lung, and Blood Institute (NHLBI)/National Institutes of Health (NIH).
- Detailed Description
While inflammation contributes crucially to atherothrombosis, it is unknown whether inhibition of inflammation per se will lower vascular event rates. The primary aim of the Cardiovascular Inflammation Reduction Trial (CIRT) is to directly test the inflammatory hypothesis of atherothrombosis by evaluating whether or not low-dose methotrexate (LDM) will reduce rates of myocardial infarction, stroke, and cardiovascular death among stable coronary artery disease patients with type 2 diabetes or metabolic syndrome, conditions associated with an enhanced pro-inflammatory response. CIRT is a randomized, double-blind, placebo-controlled, multi-center, event-driven trial that will randomize 7,000 men and women from the United States and Canada. Following a five- to six-week open-label run-in (maximum 8 weeks), eligible participants who have either suffered documented myocardial infarction in the past or have angiographically demonstrated multivessel coronary artery disease in the past will be randomly allocated over a three to four year period to usual care plus placebo or usual care plus LDM. The target methotrexate dose among those allocated to active therapy is 15 to 20 mg po per week, a dose within the range of that commonly used for the treatment of rheumatoid arthritis. All study participants will additionally receive 1.0 mg oral folate to be taken daily six days per week. LDM complications will be minimized through education programs for all investigators and coordinators, through enhanced communication with study participants, by limiting enrollment to those with no evidence of malignancy, hepatitis, renal dysfunction, chronic infection, pulmonary disease, or other risk factors for toxicity; by conducting an initial 5- to 6-week active-therapy run-in (maximum 8 weeks) designed to eliminate individuals who are either intolerant of or unable to adhere to treatment before randomization; and through regular monitoring of liver function and hematologic indices using a centralized methodology designed to ensure participant safety, allow for dose adjustments while maintaining the study blind, and provide an efficient method to address issues of compliance and follow-up on a cost-effective centralized basis. The primary trial endpoint is the rate of myocardial infarction, stroke, or cardiovascular death. Secondary and tertiary endpoints include all-cause mortality, coronary revascularization, incident congestive heart failure, incident peripheral artery disease, incident venous thrombosis, clinically significant aortic stenosis, incident atrial fibrillation, incident diabetes among those with metabolic syndrome but not diabetes at study entry, and hemoglobin A1c (HbA1c) control among those with diabetes at study entry. The trial is event driven such that in the absence of extreme effects, the trial will conclude after accrual of at least 530 primary endpoints, an effect estimated to provide 90 percent power to detect a 25 percent relative risk reduction. The potential clinical impact of CIRT is broad as it has sufficient power to directly address core issues in the inflammatory hypothesis of atherothrombosis, and thus, if successful, will open major new directions for cardiovascular treatment.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 4786
-
Age ≥ 18 years at screening
-
Documented past history of myocardial infarction OR past evidence of multivessel coronary artery disease by angiography.
- To qualify on the basis of past history of myocardial infarction, the event must be documented either by hospital records or by evidence on current ECG of Q waves in two contiguous leads and/or an imaging test demonstrating wall motion abnormality or scar. The patient must also have completed any planned coronary revascularization procedures associated with the qualifying event, and be clinically stable for at least 60 days prior to screening.
- To qualify on the basis of multivessel coronary disease, there must be past angiographic evidence of atherosclerosis in at least 2 major epicardial vessels defined either as the presence of a stent, a coronary bypass graft, or an angiographic lesion of 60% or greater. Left main coronary artery disease that has been revascularized with a stent or bypass graft will qualify as multivessel disease, as will the presence of a 50% or greater isolated left main stenosis. The patient must also have completed any planned coronary revascularization procedures associated with the qualifying event, and be clinically stable for at least 60 days prior to screening.
-
History of type 2 diabetes or metabolic syndrome at time of study enrollment
-
Willingness to participate as evidenced by signing the study informed consent
- Prior history of chronic infectious disease, tuberculosis, or severe fungal disease; chronic hepatitis B or C infection; renal insufficiency; interstitial pneumonitis, bronchiectasis, or pulmonary fibrosis; known chronic pericardial effusion, pleural effusion, or ascites; chronic liver disease; myeloproliferative disorders in the past 5 years; non-basal cell malignancy or treated lymphoproliferative disease within the past 5 years; known HIV positive; life expectancy of < 3 years;
- Chronic inflammatory condition such as lupus or rheumatoid arthritis, ulcerative colitis or Crohn's disease
- White blood cell count < 3,500/ul, hematocrit < 32 percent, or platelet count < 75,000/ul
- Liver transaminase levels (AST or ALT) >upper limit of normal (ULN) or albumin < the lower limit of normal (LLN);
- Creatinine clearance < 40 ml/min as estimated with the Cockcroft-Gault equation;
- History of alcohol abuse or unwillingness to limit alcohol consumption to less than 4 drinks per week
- Women of child bearing potential, even if they are currently using contraception, and women intending to breastfeed.
- Men who plan to father children during the study period or who are unwilling to use effective forms of contraception.
- Requirement for use of drugs that alter folate metabolism (trimethoprim/sulfamethoxazol) or reduce tubular excretion (probenecid) or known allergies to antibiotics making avoidance of trimethoprim impossible;
- Current indication for methotrexate therapy;
- Chronic use of oral steroid therapy or other immunosuppressive or biologic response modifiers. Eligible study participants will be encouraged to have up to date pneumococcal and influenza vaccinations as recommended based on their age and underlying medical conditions.
- Chest X-ray evidence in the past 12 months of interstitial pneumonitis, bronchiectasis, or pulmonary fibrosis. For participants who do not have a chest X-ray in the prior 12 months, a chest X-ray will be obtained at baseline as part of the study protocol.
- New York Heart Association Class IV congestive heart failure.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo Placebo Placebo: Tablet, Oral weekly plus 1.0mg folic acid 6 days/week Methotrexate Methotrexate Methotrexate: Tablet, Oral, Target dose 15-20mg weekly plus 1.0 mg folic acid 6 days/week
- Primary Outcome Measures
Name Time Method Number of Subjects With Major Adverse Cardiovascular Events From randomization to trial end (April 2, 2018) up to a maximum of 5 years The first occurrence of Major Adverse Cardiovascular Event which is defined as the occurrence of one or more of the following: Cardiovascular Death, Non-Fatal Myocardial Infarction or Non-Fatal Stroke.
Number of Subjects With Major Adverse Cardiovascular Event or Hospitalization for Unstable Angina That Led to Urgent Coronary Revascularization From randomization to trial end (April 2, 2018) - up to a maximum of 5 years The first occurrence of Major Adverse Cardiovascular Event or Hospitalization for Unstable Angina that led to Urgent Coronary Revascularization.
- Secondary Outcome Measures
Name Time Method Number of Subjects With Major Adverse Cardiovascular Event or Any Coronary Revascularization From randomization to the trial end (April 2, 2018) - up to a maximum of 5 years The first occurrence of Major Adverse Cardiovascular Event or Any Coronary Revascularization.
Number of Subjects With New Onset Type 2 Diabetes From randomization to the trial end (April 2, 2018) - up to 5 years New onset type 2 diabetes among those without diabetes at baseline. Baseline diabetes is defined as any of the following prior to randomization: clinician report of diabetes, use of antidiabetic medication, hbA1c \>=6.5 or fasting plasma glucose \>=126.
Number of Subjects With All-cause Mortality From randomization to the trial end (April 2, 2018) up to a maximum of 5 years Subjects who died from any cause.
Number of Subjects With Hospitalization for Congestive Heart Failure From randomization to trial end (April 2, 2018) up to a maximum of 5 years The first occurrence of Hospitalization for Congestive Heart Failure
Number of Subjects With Major Adverse Cardiovascular Event, Coronary Revascularization, Hospitalization for Congestive Heart Failure or All Cause Mortality From randomization to trial end (April 2, 2018) up to a maximum of 5 years The first occurrence of Major Adverse Cardiovascular Event, Coronary Revascularization, Hospitalization for Congestive Heart Failure or All Cause Mortality.
Trial Locations
- Locations (458)
Team Medical Research
🇺🇸Miami, Florida, United States
Indiana Heart Physicians
🇺🇸Indianapolis, Indiana, United States
Sanitas Research
🇺🇸Miami, Florida, United States
South Florida Research Group, LLC
🇺🇸Miami, Florida, United States
Vista Health Research, LLC
🇺🇸Miami, Florida, United States
Segui - Med Care Research
🇺🇸Miami, Florida, United States
D De La Vega MD Research Group
🇺🇸Miami, Florida, United States
Appalachian Research Associates
🇺🇸Fort Payne, Alabama, United States
Saadat Ansari MD LLC
🇺🇸Huntsville, Alabama, United States
Avant Research Associates, LLC
🇺🇸Port Arthur, Texas, United States
University of South Alabama: Division of Clinical Research
🇺🇸Mobile, Alabama, United States
The Heart Clinic
🇺🇸Scottsdale, Arizona, United States
Arkansas Heart Hospital
🇺🇸Little Rock, Arkansas, United States
Touro University California- Solano County Affiliated Clinics
🇺🇸Fairfield, California, United States
Arkansas Cardiology
🇺🇸Little Rock, Arkansas, United States
Oracle Clinical Research, Inc.
🇺🇸Anaheim, California, United States
Medical Group of Culver City
🇺🇸Culver City, California, United States
University Of California San Francisco
🇺🇸Fresno, California, United States
VACCHCS
🇺🇸Fresno, California, United States
UCSD Sulpizio Cardiovascular Center
🇺🇸La Jolla, California, United States
Desert Medical Care & Wellness
🇺🇸La Quinta, California, United States
Kumar Medical Corporation
🇺🇸Lancaster, California, United States
VA Loma Linda Healthcare System
🇺🇸Loma Linda, California, United States
Long Beach Center for Clinical Research
🇺🇸Long Beach, California, United States
Cardiovascular Innovation and Research
🇺🇸Long Beach, California, United States
Loma Linda University Health
🇺🇸Loma Linda, California, United States
Los Alamitos Cardiovascular
🇺🇸Los Alamitos, California, United States
Faye Montegrande Md. Clinical Research
🇺🇸Los Angeles, California, United States
Salman Khan A. Medical Corporation
🇺🇸Los Angeles, California, United States
West LA VA Medical Center
🇺🇸Los Angeles, California, United States
VA Northern California Health Care
🇺🇸Mather, California, United States
Orange County Heart Institute & Research
🇺🇸Orange, California, United States
Diverse Research Solutions
🇺🇸Oxnard, California, United States
University of CA Irvine Medical Center
🇺🇸Orange, California, United States
Central Coast Cardiology
🇺🇸Salinas, California, United States
Pacific Heart and Vascular Medical Group
🇺🇸Stockton, California, United States
Coastal Heart Medical Group, Inc.
🇺🇸Santa Ana, California, United States
Comprehensive Cardiovascular Care
🇺🇸Santa Maria, California, United States
Munni R. Selagamsetty, Md, Pc
🇺🇸Colorado Springs, Colorado, United States
Touro University California- Solano Public Health Affiliated Clinics
🇺🇸Vallejo, California, United States
Manoj D. Aswani M.D.
🇺🇸Thousand Oaks, California, United States
Colorado Health Medical Group Heart Center of the Rockies
🇺🇸Fort Collins, Colorado, United States
Unrein - Rocky Vista University Health Center
🇺🇸Parker, Colorado, United States
Medical Center of the Rockies Research
🇺🇸Fort Collins, Colorado, United States
Connecticut Heart and Vascular Center
🇺🇸Bridgeport, Connecticut, United States
Bridgeport Hospital
🇺🇸Bridgeport, Connecticut, United States
Boisey Barnes MD, PC
🇺🇸Washington, District of Columbia, United States
Gonzalez MD & Aswad MD Health Ser
🇺🇸Coral Gables, Florida, United States
Pianko - Aventura Research Center, LLC
🇺🇸Aventura, Florida, United States
St. Francis Medical Institute
🇺🇸Clearwater, Florida, United States
Seidman Clinical Trials
🇺🇸Delray Beach, Florida, United States
American Research Institute, Inc.
🇺🇸Cutler Bay, Florida, United States
Daytona Heart Group
🇺🇸DeLand, Florida, United States
Steven Cohen MD
🇺🇸Delray Beach, Florida, United States
Infinite Clinical Research
🇺🇸Doral, Florida, United States
Invesclinic
🇺🇸Fort Lauderdale, Florida, United States
Lake Internal Medicine Assocaties
🇺🇸Eustis, Florida, United States
International Research Partners, LLC
🇺🇸Doral, Florida, United States
Medical Research Institute at Doral, Inc.
🇺🇸Doral, Florida, United States
Primary Care Associates
🇺🇸Fort Myers, Florida, United States
Lee Physician Group
🇺🇸Fort Myers, Florida, United States
Qway Research
🇺🇸Hialeah, Florida, United States
Healing Touch C&C Research
🇺🇸Hialeah, Florida, United States
State of the Art Research
🇺🇸Hialeah, Florida, United States
Viviana Perez MD Research & Cosmetics
🇺🇸Hialeah, Florida, United States
Luzmed Clinical Research Institute
🇺🇸Hialeah, Florida, United States
Nova Clinical Research Clinic
🇺🇸Hialeah, Florida, United States
Elite Cardiac Research Center LLC
🇺🇸Hialeah, Florida, United States
South Florida Research Solutions, LLC
🇺🇸Hollywood, Florida, United States
Best Quality Research, Inc.
🇺🇸Hialeah, Florida, United States
Hope Clinical Research
🇺🇸Kissimmee, Florida, United States
Cardiovascular Medical Associates of Palm Beach
🇺🇸Jupiter, Florida, United States
SIH Research, LLC
🇺🇸Kissimmee, Florida, United States
Lakes Research, LLC
🇺🇸Miami Lakes, Florida, United States
Ocean Blue Medical Research Center
🇺🇸Miami Springs, Florida, United States
Veritas Research Corp.
🇺🇸Miami Lakes, Florida, United States
St. Paul Medical Research Center, Inc.
🇺🇸Miami, Florida, United States
Medical Research Center of Florida
🇺🇸Miami, Florida, United States
LG Diagnostics, Inc.
🇺🇸Miami, Florida, United States
Paradise Clinical Research, LLC
🇺🇸Miami, Florida, United States
GAD Research Center
🇺🇸Miami, Florida, United States
Innovation Research Institute, Inc.
🇺🇸Miami, Florida, United States
Southwest Florida Research, LLC
🇺🇸Naples, Florida, United States
Palm Beach Gardens Research Center, LLC
🇺🇸Palm Beach Gardens, Florida, United States
Broward Research Center
🇺🇸Pembroke Pines, Florida, United States
Pioneer Clinical Research
🇺🇸Pembroke Pines, Florida, United States
Richard G. Friedman, MD
🇺🇸San Diego, California, United States
Ritchken and First MDs
🇺🇸San Diego, California, United States
Foundation for Cardiovascular Medicine
🇺🇸San Diego, California, United States
San Diego Cardiac Center
🇺🇸San Diego, California, United States
Veterans Affairs San Diego Healthcare System
🇺🇸San Diego, California, United States
Bay Area Heart Center: 49th Street
🇺🇸Saint Petersburg, Florida, United States
Sandoval - Broward Research Center
🇺🇸Pembroke Pines, Florida, United States
Bay Area Heart Center: 7th Avenue
🇺🇸Saint Petersburg, Florida, United States
Lenus Research & Medical Group
🇺🇸Sweetwater, Florida, United States
DBC Research
🇺🇸Tamarac, Florida, United States
Asclepes Research Centers
🇺🇸Weeki Wachee, Florida, United States
Gupta - Premier Heart and Vascular Center
🇺🇸Wesley Chapel, Florida, United States
Atlanta Veterans Affairs Medical Center
🇺🇸Atlanta, Georgia, United States
Athens Regional Medical Center
🇺🇸Athens, Georgia, United States
Laureate Medical Group at Northside
🇺🇸Atlanta, Georgia, United States
Synergy Therapeutic Partners
🇺🇸Atlanta, Georgia, United States
Northside Hospital
🇺🇸Atlanta, Georgia, United States
Atlanta Heart Specialists, LLC
🇺🇸Tucker, Georgia, United States
Heart and Rhythm Specialists
🇺🇸Dalton, Georgia, United States
Albert F. Johary MD, PC
🇺🇸Dunwoody, Georgia, United States
Infinite Clinical Trials
🇺🇸Riverdale, Georgia, United States
Atlanta Vanguard Medical Associates
🇺🇸Smyrna, Georgia, United States
Herman Clinical Research, LLC
🇺🇸Suwanee, Georgia, United States
Cardiology Associates of Vidalia, P.C.
🇺🇸Vidalia, Georgia, United States
St. Luke's Idaho Cardiology Associates
🇺🇸Boise, Idaho, United States
Clinical Research Prime
🇺🇸Idaho Falls, Idaho, United States
Northwest Heart Clinical Research
🇺🇸Arlington Heights, Illinois, United States
Advocate Med Group-Heart & Vascular Of Illinois
🇺🇸Chicago, Illinois, United States
Captain James A. Lovell Federal Health
🇺🇸North Chicago, Illinois, United States
Illinois Heart & Lung Research Center, SC
🇺🇸Normal, Illinois, United States
University of Chicago Medical Center
🇺🇸Chicago, Illinois, United States
Specialty Physicians of Illinois, LLC
🇺🇸Olympia Fields, Illinois, United States
Cardiospecialists, LTD
🇺🇸Dyer, Indiana, United States
Advanced CardioVascular Consultants
🇺🇸Rock Island, Illinois, United States
Martin - Martin Family Practice and Research
🇺🇸Evansville, Indiana, United States
Krannert Institute Of Cardiology
🇺🇸Indianapolis, Indiana, United States
Community Hospital South
🇺🇸Indianapolis, Indiana, United States
Medical Consultants, PC
🇺🇸Muncie, Indiana, United States
Iowa Heart Center
🇺🇸West Des Moines, Iowa, United States
Research Integrity LLC
🇺🇸Owensboro, Kentucky, United States
Dorothy H. Banish, MD, APMC Study Group
🇺🇸Covington, Louisiana, United States
American Clinical Research, LLC
🇺🇸Marrero, Louisiana, United States
Otis Barnum D.O.P.C.
🇺🇸Natchitoches, Louisiana, United States
Paul A. Shapero, M.D.
🇺🇸Bangor, Maine, United States
Maine Medical Partners Maine Health Cardiology
🇺🇸South Portland, Maine, United States
Southern Maine Health Care
🇺🇸Biddeford, Maine, United States
Sinai Center for Thrombosis Research
🇺🇸Baltimore, Maryland, United States
St. Mary's Medical Center
🇺🇸Charlotte Hall, Maryland, United States
Calvert Memorial Hospital
🇺🇸Clinton, Maryland, United States
IRC Clinics
🇺🇸Towson, Maryland, United States
Peninsula Cardiology Associates
🇺🇸Salisbury, Maryland, United States
Shah Associates, MD, LLC
🇺🇸Prince Frederick, Maryland, United States
Brigham and Women's Hospital
🇺🇸Boston, Massachusetts, United States
St. Elizabeth's Medical Center
🇺🇸Boston, Massachusetts, United States
MGH Cardiology
🇺🇸Boston, Massachusetts, United States
Lahey Hospital and Medical Center
🇺🇸Burlington, Massachusetts, United States
Massachusetts General Hospital - Chelsea Health Care Center
🇺🇸Chelsea, Massachusetts, United States
VA Central Western Massachusetts Healthca
🇺🇸Leeds, Massachusetts, United States
Pentucket Medical Associates, Inc.
🇺🇸Haverhill, Massachusetts, United States
South Shore Internal Medicine
🇺🇸Milton, Massachusetts, United States
Lahey Medical Center
🇺🇸Peabody, Massachusetts, United States
North Shore Cardiovascular Associates
🇺🇸Salem, Massachusetts, United States
Reliant Medical Group
🇺🇸Worcester, Massachusetts, United States
Apex Medical Research MI, Inc.
🇺🇸Flint, Michigan, United States
Flint Clinical Research
🇺🇸Flint, Michigan, United States
Garden City Hospital
🇺🇸Garden City, Michigan, United States
Genesys Regional Medical Center
🇺🇸Grand Blanc, Michigan, United States
Academic Cardiology Associates PC
🇺🇸Rochester Hills, Michigan, United States
National Clinical LLC
🇺🇸Hamtramck, Michigan, United States
Beaumont Health Center
🇺🇸Royal Oak, Michigan, United States
Covenant Medical Center, Inc.
🇺🇸Saginaw, Michigan, United States
Mid-Michigan Heart & Vascular Center
🇺🇸Saginaw, Michigan, United States
Centra Care Heart & Vascular Center at St. Cloud Hospital
🇺🇸Saint Cloud, Minnesota, United States
United Heart and Vascular Clinic
🇺🇸Saint Paul, Minnesota, United States
David M. Headley M.D. PA Planters Clinic
🇺🇸Port Gibson, Mississippi, United States
Center for Advanced Medicine and Research LLC
🇺🇸Bridgeton, Missouri, United States
Clinical Research Center University of Missouri
🇺🇸Columbia, Missouri, United States
Quantum Research LLC
🇺🇸Festus, Missouri, United States
Midwest Cardiology Associates
🇺🇸Independence, Missouri, United States
Freeman Health System
🇺🇸Joplin, Missouri, United States
VA St. Louis Health Care System (VASTLHCS)
🇺🇸Saint Louis, Missouri, United States
Lake Regional Cardiovascular Institute
🇺🇸Osage Beach, Missouri, United States
SLUCare Cardiology
🇺🇸Saint Louis, Missouri, United States
Washington University
🇺🇸Saint Louis, Missouri, United States
Clinical Investigators LLC
🇺🇸Saint Louis, Missouri, United States
Consult and Research Associates
🇺🇸Saint Louis, Missouri, United States
CoxHealth: Wheeler Heart & Vascular Center
🇺🇸Springfield, Missouri, United States
Center for Advanced Medicine and Research
🇺🇸Saint Peters, Missouri, United States
Cone - Montana Medical Research
🇺🇸Missoula, Montana, United States
Mercy Medical Research Institute
🇺🇸Springfield, Missouri, United States
Barrett Clinic, P.C.
🇺🇸La Vista, Nebraska, United States
Internal Medicine Clinic
🇺🇸Las Vegas, Nevada, United States
Sierra Nevada Health Care System
🇺🇸Reno, Nevada, United States
Red Rock Clinical Research, LLC
🇺🇸Las Vegas, Nevada, United States
Renown Inst for Heart & Vasc Health
🇺🇸Reno, Nevada, United States
Family Health at Mount Olive
🇺🇸Flanders, New Jersey, United States
Cardiocare
🇺🇸Hillsborough, New Jersey, United States
New Jersey Heart
🇺🇸Linden, New Jersey, United States
Palisade Medical Center
🇺🇸North Bergen, New Jersey, United States
Cardiovascular Institute
🇺🇸New Brunswick, New Jersey, United States
Mercer Bucks Cardiology
🇺🇸Robbinsville, New Jersey, United States
Holy Name Medical Center, Inc.
🇺🇸Teaneck, New Jersey, United States
Total Cardiology Care, LLC
🇺🇸Wayne, New Jersey, United States
Albany Medical College
🇺🇸Albany, New York, United States
Albany Stratton VA Medical Center
🇺🇸Albany, New York, United States
Brown - SUNY Downstate Medical Center
🇺🇸Brooklyn, New York, United States
Buffalo Heart Group
🇺🇸Buffalo, New York, United States
Bassett Healthcare Network
🇺🇸Cooperstown, New York, United States
NYHQ
🇺🇸Flushing, New York, United States
NYU Hudson Valley Cardiology
🇺🇸Cortlandt Manor, New York, United States
Winthrop University Hospital
🇺🇸Mineola, New York, United States
Long Island Heart Associates
🇺🇸Mineola, New York, United States
Long Island Jewish Medical Center
🇺🇸New Hyde Park, New York, United States
Queens Long Island Medical Group
🇺🇸New Hyde Park, New York, United States
Chinatown Cardiology, PC
🇺🇸New York, New York, United States
Weill Cornell Medical College and NY Presbyterian
🇺🇸New York, New York, United States
Mount Sinai School of Medicine
🇺🇸New York, New York, United States
Champlain Valley Physician Hospital
🇺🇸Plattsburgh, New York, United States
DiGiovanna Institute for Medical Education and Research
🇺🇸North Massapequa, New York, United States
Clinical Study Center of Asheville
🇺🇸Asheville, North Carolina, United States
Cardiology Associates of Schenectady
🇺🇸Schenectady, New York, United States
Gaffney Health Services
🇺🇸Charlotte, North Carolina, United States
Carolinas Research Center
🇺🇸Charlotte, North Carolina, United States
Lake Shore Clinical Research, LLC.
🇺🇸Mooresville, North Carolina, United States
Northside Clinical Research
🇺🇸Lenoir, North Carolina, United States
Eastern Carolina Cardiovascular, PA
🇺🇸Elizabeth City, North Carolina, United States
Eastern Cardiology
🇺🇸Greenville, North Carolina, United States
Carteret Medical Group
🇺🇸Morehead City, North Carolina, United States
Eastern Nephrology Associates, PLLC
🇺🇸New Bern, North Carolina, United States
Cardiology Associates of Carolinas, PA
🇺🇸Morganton, North Carolina, United States
Boice Willis Clinic
🇺🇸Rocky Mount, North Carolina, United States
Sanford Cardiology
🇺🇸Sanford, North Carolina, United States
Natalie A. Doyle, MD, PA
🇺🇸Wilson, North Carolina, United States
Akron General Medical Center
🇺🇸Akron, Ohio, United States
The Lindner Research Center
🇺🇸Cincinnati, Ohio, United States
Diabetes and Endocrinology Associates of Stark Cit
🇺🇸Canton, Ohio, United States
Cleveland Clinic
🇺🇸Cleveland, Ohio, United States
Ohio University Heritage College of Osteopathic Medicine
🇺🇸Athens, Ohio, United States
Optimed Research, LTD
🇺🇸Columbus, Ohio, United States
Colonnade Medical Group
🇺🇸Lancaster, Ohio, United States
Middletown Cardiovascular Associates
🇺🇸Middletown, Ohio, United States
Comprehensive Heart Care, Inc.
🇺🇸Toledo, Ohio, United States
Mount Carmel Clinical Cardiovascular Care
🇺🇸Westerville, Ohio, United States
Premier Physicians
🇺🇸Westlake, Ohio, United States
Unity Clinical Research
🇺🇸Lindsay, Oklahoma, United States
Wooster Heart Group
🇺🇸Wooster, Ohio, United States
Oklahoma State University Center for Health Sciences
🇺🇸Tulsa, Oklahoma, United States
Samaritan Health Services
🇺🇸Corvallis, Oregon, United States
Southern Oregon Cardiology, LLC
🇺🇸Medford, Oregon, United States
Main Line Health Center, Broomall
🇺🇸Broomall, Pennsylvania, United States
Center for Clinical Res. Abington Health
🇺🇸Abington, Pennsylvania, United States
Renu-Ca Research Institute, Lower Bucks Hospital
🇺🇸Bristol, Pennsylvania, United States
St. Luke's University Hospital
🇺🇸Bethlehem, Pennsylvania, United States
Spirit Physician Services, Inc
🇺🇸Camp Hill, Pennsylvania, United States
The Chambersburg Hospital
🇺🇸Chambersburg, Pennsylvania, United States
Central Bucks Cardiology
🇺🇸Doylestown, Pennsylvania, United States
Saint Vincent Consultants in Cardiovascular Diseases, LLC
🇺🇸Erie, Pennsylvania, United States
Heart Specialists of Lancaster County
🇺🇸Ephrata, Pennsylvania, United States
Altoona Center for Clinical Research
🇺🇸Duncansville, Pennsylvania, United States
Feasterville Family Healthcare Center
🇺🇸Feasterville, Pennsylvania, United States
Pinnacle Health Cardiovascular Institute
🇺🇸Harrisburg, Pennsylvania, United States
George Isajiw, MD
🇺🇸Lansdowne, Pennsylvania, United States
Christiana Care Health System
🇺🇸Glen Mills, Pennsylvania, United States
Bucks County Clinical Research
🇺🇸Morrisville, Pennsylvania, United States
Drexel University College of Medicine
🇺🇸Philadelphia, Pennsylvania, United States
Hospital of the University of Pennsylvania
🇺🇸Philadelphia, Pennsylvania, United States
Lehigh Valley Family Practice
🇺🇸Whitehall, Pennsylvania, United States
Pish Medical Associates, Inc.
🇺🇸Uniontown, Pennsylvania, United States
Lehigh Valley Health Services
🇺🇸Sellersville, Pennsylvania, United States
Wilkes-Barre VA Medical Center
🇺🇸Wilkes-Barre, Pennsylvania, United States
Ocean State Clinical Research Prtnr
🇺🇸Lincoln, Rhode Island, United States
Partners in Clinical Research
🇺🇸Cumberland, Rhode Island, United States
Memorial Hospital of Rhode Island
🇺🇸Pawtucket, Rhode Island, United States
The Miriam Hospital
🇺🇸Providence, Rhode Island, United States
Ocean State Research Institute, Inc
🇺🇸Providence, Rhode Island, United States
South Carolina Heart Center
🇺🇸Columbia, South Carolina, United States
Charlotte Hearts
🇺🇸Indian Land, South Carolina, United States
Miller - SC Internal Medicine Associates.: Irmo
🇺🇸Irmo, South Carolina, United States
Fusion Clinical Research of Spartanburg
🇺🇸Spartanburg, South Carolina, United States
Inlet Cardiopulmonary & Associates
🇺🇸Pawleys Island, South Carolina, United States
Palmetto Research Center, LLC
🇺🇸Spartanburg, South Carolina, United States
New Phase Research & Development
🇺🇸Knoxville, Tennessee, United States
Parkway Medical Group
🇺🇸Fayetteville, Tennessee, United States
Kore Cardiovascular Research Institutue
🇺🇸Jackson, Tennessee, United States
Cardiovascular Research of Knoxville
🇺🇸Knoxville, Tennessee, United States
Ramanathan - VAMC Memphis
🇺🇸Memphis, Tennessee, United States
Cornerstone Family Medicine
🇺🇸Big Spring, Texas, United States
Southeast TX Clinical Research Center
🇺🇸Beaumont, Texas, United States
IMD Medical Center
🇺🇸Carrollton, Texas, United States
Texas Health Physicians Group
🇺🇸Fort Worth, Texas, United States
The Heart Center of Dallas
🇺🇸Dallas, Texas, United States
Cardiovascular Research Institute of Dallas
🇺🇸Dallas, Texas, United States
North Texas Health Center
🇺🇸Dallas, Texas, United States
Global Medical Research
🇺🇸DeSoto, Texas, United States
The Medical Group of Texas
🇺🇸Fort Worth, Texas, United States
Michele P. Sartori, MD
🇺🇸Houston, Texas, United States
T&R Clinic, P.A.
🇺🇸Haltom City, Texas, United States
Grand Medical Care
🇺🇸Katy, Texas, United States
Team Research Of Central Texas
🇺🇸Killeen, Texas, United States
Houston Heart and Vascular Associates
🇺🇸Kingwood, Texas, United States
Grace Research, LLC
🇺🇸Palestine, Texas, United States
Valley Heart Consultants
🇺🇸McAllen, Texas, United States
Heart Center, Palo Pinto General Hospital
🇺🇸Mineral Wells, Texas, United States
Valley Central Research Inc
🇺🇸Mission, Texas, United States
North Hills Medical Research, Inc
🇺🇸North Richland Hills, Texas, United States
Lone Star Heart and Vascular Center
🇺🇸Tomball, Texas, United States
Acacia Medical Research Institute
🇺🇸Sugar Land, Texas, United States
Health Plus Clinical Research
🇺🇸Sugar Land, Texas, United States
Northwest Houston Clinical Research
🇺🇸Tomball, Texas, United States
Hillcrest Family Health Center
🇺🇸Waco, Texas, United States
Utah Cardiology, P.C.
🇺🇸Layton, Utah, United States
Hampton Family Practice Research
🇺🇸Hampton, Virginia, United States
Seven Corners Medical Research Center
🇺🇸Falls Church, Virginia, United States
Burke Internal Medicine & Research
🇺🇸Burke, Virginia, United States
Tidewater Physicians Multispecialty Group
🇺🇸Yorktown, Virginia, United States
Manassas Clinical Research Center
🇺🇸Manassas, Virginia, United States
TPMG Clinical Research
🇺🇸Newport News, Virginia, United States
Virginia Cardiovascular Associates
🇺🇸Manassas, Virginia, United States
Tucker Cardiology Associates, P.C.
🇺🇸Mechanicsville, Virginia, United States
Sentara Norfolk General Hospital
🇺🇸Norfolk, Virginia, United States
Frandsen Family Medicine DBA Sound Medi
🇺🇸Port Orchard, Washington, United States
Roanoke Heart Institute PLC
🇺🇸Roanoke, Virginia, United States
Cardinal Internal Medicine Associates
🇺🇸Woodbridge, Virginia, United States
Premier Clinical Research
🇺🇸Spokane, Washington, United States
Kootenai Heart Clinics, LLC
🇺🇸Spokane, Washington, United States
Northwest Medical Associates, P.S.
🇺🇸Vancouver, Washington, United States
Cardiology Associates of Bellin Health
🇺🇸Green Bay, Wisconsin, United States
Northside Internal Medicine
🇺🇸Spokane, Washington, United States
Marshfield Clinic
🇺🇸Marshfield, Wisconsin, United States
The Medical Arts Health Research Group
🇨🇦Penticton, British Columbia, Canada
Bramalea Medical Centre
🇨🇦Brampton, Ontario, Canada
Brampton Research Associates
🇨🇦Brampton, Ontario, Canada
Vizel Cardiac Research
🇨🇦Cambridge, Ontario, Canada
Dr. Linda Sinnaeve's Office
🇨🇦Chatham, Ontario, Canada
Philippe R Beaudry Medicine Professional Corporation
🇨🇦Burlington, Ontario, Canada
Scisco Clinical Research
🇨🇦Cornwall, Ontario, Canada
KMH Cardiology & Diagnostics: Hamilton
🇨🇦Hamilton, Ontario, Canada
John Stimac, MD
🇨🇦Hamilton, Ontario, Canada
Dr. Peter Spadafora Health Center
🇨🇦Guelph, Ontario, Canada
Dr. William Liang
🇨🇦Hamilton, Ontario, Canada
University Hospital
🇨🇦London, Ontario, Canada
Dr. Ronald Fowlis
🇨🇦Kitchener, Ontario, Canada
Malton Medical Research
🇨🇦Mississauga, Ontario, Canada
KMH Cardiology & Diagnostics: Mississauga
🇨🇦Mississauga, Ontario, Canada
Newmarket Cardiology Research Group
🇨🇦Newmarket, Ontario, Canada
Portage Medical Centre
🇨🇦Niagara Falls, Ontario, Canada
Humber River Regional Hospital
🇨🇦North York, Ontario, Canada
Bakbak Medicine Professional Corporation
🇨🇦Oshawa, Ontario, Canada
Dr. James Y. Cha
🇨🇦Oshawa, Ontario, Canada
University Of Ottawa Heart Institute
🇨🇦Ottawa, Ontario, Canada
Kawartha Cardiology Clinical Trials
🇨🇦Peterborough, Ontario, Canada
Steeple Hill Medical Centre
🇨🇦Pickering, Ontario, Canada
Scarborough Cardiology Research
🇨🇦Scarborough, Ontario, Canada
Sarnia Institute Of Clinical Research
🇨🇦Sarnia, Ontario, Canada
Scarborough General Hospital Cardiology Research Associates
🇨🇦Scarborough, Ontario, Canada
Canadian Centre for Research on Diabetes
🇨🇦Smith Falls, Ontario, Canada
Lake Shore Cardiology
🇨🇦St. Catharines, Ontario, Canada
Sardar Medical Clinic
🇨🇦St. Thomas, Ontario, Canada
G.S. Cardiac Lab Medicine Professional Corp
🇨🇦Sudbury, Ontario, Canada
Dr. R. Labonte Professional Med Corp
🇨🇦Sudbury, Ontario, Canada
Dr. G. Garrioch, Independent Practice
🇨🇦Sudbury, Ontario, Canada
Dr. Laurence Gibbs Medicine Professional Corp.
🇨🇦Thedford, Ontario, Canada
Tillsonburg Medical Centre
🇨🇦Tillsonburg, Ontario, Canada
Sunnybrook Health Sciences Centre
🇨🇦Toronto, Ontario, Canada
Mount Sinai Hospital
🇨🇦Toronto, Ontario, Canada
St. Michael's Hospital
🇨🇦Toronto, Ontario, Canada
Weston Road Medical Clinic
🇨🇦Toronto, Ontario, Canada
Dr. Nwadiaro Medicine Professional Corp
🇨🇦Windsor, Ontario, Canada
CHUM Hotel-Dieu
🇨🇦Montreal, Quebec, Canada
Iucpq
🇨🇦Quebec City, Quebec, Canada
ALPHA Recherche Clinique
🇨🇦Québec, Quebec, Canada
Viacar Recherche Clinique
🇨🇦St. Lambert, Quebec, Canada
Recherche Clinique Sigma, Inc.
🇨🇦Quebec, Canada
Yolanda Sierra Quinones, MD
🇵🇷Toa Baja, Puerto Rico
Santoscoy - Health Texas Research Institute
🇺🇸San Antonio, Texas, United States
Element Research Group
🇺🇸San Antonio, Texas, United States
Schnitzler Cardiovascular Consultants
🇺🇸San Antonio, Texas, United States
San Antonio Endovascular & Heart Institute
🇺🇸San Antonio, Texas, United States
Altru Health System Rehab Center
🇺🇸Grand Forks, North Dakota, United States
Winnipeg Clinic
🇨🇦Winnipeg, Manitoba, Canada
Stahl - Midwest Heart & Vascular Specialists
🇺🇸Overland Park, Kansas, United States
University of Southern California
🇺🇸Los Angeles, California, United States
UCSF at Zuckerberg SF General Hospital
🇺🇸San Francisco, California, United States
Clinical Research Center Meharry Medical College
🇺🇸Nashville, Tennessee, United States
Utah Diabetes Center
🇺🇸Salt Lake City, Utah, United States
Stern Cardiovascular Foundation, Inc.
🇺🇸Germantown, Tennessee, United States
Arizona Arthritis & Rheumatology Research
🇺🇸Phoenix, Arizona, United States
Sewa Ram Singal Medicine Professional Corporation
🇨🇦Mississauga, Ontario, Canada
Humber River Hospital
🇨🇦Toronto, Ontario, Canada
Toronto General Hospital
🇨🇦Toronto, Ontario, Canada
Milliken Medical Centre
🇨🇦Scarborough, Ontario, Canada
Source Unique Clinic
🇨🇦Hawkesbury, Ontario, Canada
Dr. Nigel Jagan Medicine Professional Corporation
🇨🇦Whitby, Ontario, Canada
University of Alabama at Birmingham
🇺🇸Birmingham, Alabama, United States
Vijay - Aurora Denver Cardiology
🇺🇸Denver, Colorado, United States
John D. Dingell Veterans Affairs Medical Center
🇺🇸Detroit, Michigan, United States
Trace Research Group at Wayne State University
🇺🇸Detroit, Michigan, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Heart Consultants
🇺🇸Omaha, Nebraska, United States
Alegent Creighton Health
🇺🇸Omaha, Nebraska, United States
University of Nebraska Medical Center
🇺🇸Omaha, Nebraska, United States
COR Clinical Research, LLC
🇺🇸Oklahoma City, Oklahoma, United States
Thadani - VA Medical Center Oklahoma City, OK
🇺🇸Oklahoma City, Oklahoma, United States
Today Clinical Research
🇺🇸Oklahoma City, Oklahoma, United States
Cardiovascular Health Clinic
🇺🇸Oklahoma City, Oklahoma, United States
Oregon Health & Science University
🇺🇸Portland, Oregon, United States
Columbia St. Mary's
🇺🇸Milwaukee, Wisconsin, United States
Aurora St. Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Jamaica Hospital Medical Center
🇺🇸Jamaica, New York, United States
Eastside Clinical Research Associates
🇺🇸Los Angeles, California, United States
Huntington Memorial Hospital
🇺🇸Pasadena, California, United States
Southern Arizona VA Health Care System
🇺🇸Tucson, Arizona, United States
North Ridge Heart Associates
🇺🇸Boca Raton, Florida, United States
Heart Vascular of Northern Arizona
🇺🇸Cottonwood, Arizona, United States
InterMed, PA
🇺🇸Portland, Maine, United States
Scottsdale Medical Imaging
🇺🇸Scottsdale, Arizona, United States
North Oaks Cardiology
🇺🇸Hammond, Louisiana, United States
Maine Research Associates
🇺🇸Auburn, Maine, United States
Pima Heart
🇺🇸Tucson, Arizona, United States
GWU Medical Faculty Associatin, Inc.
🇺🇸Washington, District of Columbia, United States
Cardiology Physicians/Red Clay Research
🇺🇸Newark, Delaware, United States
CardioVascular Associates of Mesa
🇺🇸Mesa, Arizona, United States
Ecogene-21
🇨🇦Chicoutimi, Quebec, Canada
Q&T Research Chicoutimi
🇨🇦Chicoutimi, Quebec, Canada
ViaCar Recherche Clinique Inc
🇨🇦Saint-Lambert, Quebec, Canada
Cardiometabolic Research Center
🇵🇷Ponce, Puerto Rico
Miguel Sosa-Padilla, MD
🇵🇷San Juan, Puerto Rico
University Of California San Diego
🇺🇸La Jolla, California, United States
University of MS Medical Center
🇺🇸Jackson, Mississippi, United States
CardioVasc HR
🇨🇦Saint-Jean-sur-Richelieu, Quebec, Canada
Jersey Shore University Medical Center
🇺🇸Neptune, New Jersey, United States
Viacar Recherche Clinique Inc.
🇨🇦Greenfield Park, Quebec, Canada
Joslin Diabetes Center
🇺🇸Boston, Massachusetts, United States
San Juan Bautista School of Medicine
🇵🇷Caguas, Puerto Rico
Gulfside Clinical Research, LLC
🇺🇸Gulfport, Mississippi, United States
Veterans Affairs Medical Center Shreveport
🇺🇸Shreveport, Louisiana, United States
The Valley Hospital
🇺🇸Ridgewood, New Jersey, United States
Cardio Metabolic Institute
🇺🇸Somerset, New Jersey, United States
Maine Centers for Healthcare
🇺🇸Westbrook, Maine, United States
Great Falls Clinic Clinical Research Deptartment
🇺🇸Great Falls, Montana, United States
Hopital Pierre-Le Gardeur
🇨🇦Terrebonne, Quebec, Canada
Lahey Cardiology
🇺🇸Nashua, New Hampshire, United States
VA Medical Center, White River Junction
🇺🇸White River Junction, Vermont, United States
Instituto Sanacoop
🇵🇷Bayamón, Puerto Rico
Norma S. Severino-Pacheco, MD
🇵🇷Canovanas, Puerto Rico
Amistad Research Center, LLC
🇺🇸Columbia, South Carolina, United States
Westwood Cardiology Associates
🇺🇸Westwood, New Jersey, United States
Robley Rex VAMC
🇺🇸Louisville, Kentucky, United States
Stoddard - University of Louisville
🇺🇸Louisville, Kentucky, United States
Bays - L-MARC Research Center
🇺🇸Louisville, Kentucky, United States
VA Medical Center Kansas City
🇺🇸Kansas City, Missouri, United States
Orlando Healthy Heart Institute
🇺🇸Orlando, Florida, United States
The Cardiac and Vascular Institute
🇺🇸Gainesville, Florida, United States
University of Florida
🇺🇸Gainesville, Florida, United States
VA Pacific Islands Health Care System
🇺🇸Honolulu, Hawaii, United States
University of Kentucky
🇺🇸Lexington, Kentucky, United States
Tulane University Office of Health Research
🇺🇸New Orleans, Louisiana, United States
Presbyterian Heart Group
🇺🇸Albuquerque, New Mexico, United States
Novel Research of New York, LLC
🇺🇸Bronx, New York, United States
Avant Research Associates LLC
🇺🇸Austin, Texas, United States
Texas Heart and Vascular Research, LLC
🇺🇸Austin, Texas, United States
University Of Wisconsin
🇺🇸Madison, Wisconsin, United States
Dean Foundation
🇺🇸Madison, Wisconsin, United States
Professional Research Network of KS
🇺🇸Wichita, Kansas, United States
Robert J. Dole VAMC
🇺🇸Wichita, Kansas, United States
Dayton Heart Center
🇺🇸Dayton, Ohio, United States
Dayton Veteran Affairs Medical Center
🇺🇸Dayton, Ohio, United States
Metrolina Internal Medicine
🇺🇸Charlotte, North Carolina, United States
Valley Clinical Trials, Inc.
🇺🇸Northridge, California, United States
Endeavor Medical Research
🇺🇸Alpena, Michigan, United States
John Gutleber Medical Research Office
🇺🇸Homestead, Florida, United States
Montefiore Medical Center
🇺🇸Bronx, New York, United States