Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Large Scale Clinical Trial Testing the Effects of n-3 PUFA and Rosuvastatin on Mortality-Morbidity of Patients With Symptomatic Congestive Heart Failure
Brief Summary: INTRODUCTION While pharmacological treatments specifically targeted to the cardio-circulatory system have been largely investigated, scanty controlled data are available concerning the role of dietary and metabolic approaches in the management/outcome of patients with heart failure. A large scale, randomized, clinical trial is proposed to test the effects of (a) n-3 PUFA and (b) a lipid lowering agent on top of the best recommended treatments for heart failure.

STUDY DESIGN

The GISSI-HF is a prospective, multicenter, randomized, double blind, placebo controlled study, with randomized allocation of patients with a clinical diagnosis of heart failure to:

Randomization 1 (R1): n-3 PUFA 1 g daily vs corresponding placebo; Randomization 2 (R2): rosuvastatin 10 mg daily vs corresponding placebo.

OBJECTIVES OF THE STUDY PRIMARY OBJECTIVES

To demonstrate that, in patients with heart failure treated at the best of recommended therapies, long term administration of (a) n-3 PUFA, (b) rosuvastatin is more effective than the corresponding placebo in the reduction of:

* All-cause mortality
* All-cause mortality or hospitalizations for cardiovascular reason

OTHER END-POINT MEASURES OF EFFICACY

To assess that long term administration of (a) n-3 PUFA, (b) rosuvastatin is more effective than corresponding placebo in the reduction of:

* Cardiovascular mortality
* Cardiovascular mortality or hospitalizations for any reason
* Sudden cardiac death
* Hospitalizations for any reason
* Hospitalizations for cardiovascular reasons
* Hospitalizations for congestive heart failure
* Myocardial infarction
* Stroke


Options:
A: Inclusion Criteria:

1. Age \> 18 years
2. Written informed consent
3. Non-valvular paroxysmal or persistent AF in whom a rhythm control strategy is planned
4. Duration of at least one symptomatic AF episode \> 10 minutes within the past 6 months
5. ECG documentation of AF

Exclusion Criteria:

1. Chronic AF (continuously present for \> 3 months)
2. Myocardial infarction within the past month prior to selection visit
3. Cardiac or thoracic surgery within the past 3 months or likely to be performed during trial
4. Moderate to severe congestive heart failure (NHYA FC III-IV)
5. Known left ventricular dysfunction (EF\< 40%).
6. Mitral stenosis
7. Moderate to severe mitral insufficiency (Grade 3-4/4)
8. AF secondary to an acute reversible condition (untreated or uncontrolled hyperthyroidism, post- operative AF, fever, anemia)
9. Need for anti-arrhythmic therapy for a condition other than atrial fibrillation
10. Wolff-Parkinson-White syndrome
11. Any medical condition making compliance with study treatment unlikely
12. Current use of n-3 fatty acid supplements or use within the past 3 months
13. Pregnancy, breastfeeding, or possibility of becoming pregnant during the study (Patients must have adequate contraception as determined by the investigator),
14. Participation in another study at the same time or within 30 days of randomization.
15. Uncontrolled hypertension (systolic blood pressure \> 180 mm Hg or diastolic blood pressure \> 110 mm Hg
16. Suspected or known allergy to any ingredients in the study product or placebo, fish or shellfish .
B: Inclusion Criteria:

* Clinical evidence of heart failure according to the European Society of Cardiology guidelines (New York Heart Association class II-IV) (32)
* Any left ventricular Ejection Fraction (EF) measured within 3 months from enrolment (if EF% \>40%, at least 1 hospital admission for Congestive Heart Failure(CHF) in the previous year)
* No age limits
* Any etiology
* Informed consent (obtained before any study specific procedure)

Exclusion Criteria:

COMMON EXCLUSION CRITERIA (R1=n-3 PUFA vs placebo and R2=rosuvastatin vs placebo):

* Acute Myocardial Infarction, unstable angina or revascularization procedure within 1 month;
* planned cardiac surgery, expected to be performed within 3 months;
* congenital or primary valvular etiology;
* known hypersensitivity to study treatments;
* significant liver disease;
* pregnant or lactating women or women of childbearing potential who are not protected from pregnancy by an accepted method of contraception;
* any condition that in the opinion of the investigator would jeopardize the evaluation of efficacy or safety or be associated with poor adherence to the protocol;
* presence of any non-cardiac disease (e.g. cancer) that is likely to significantly shorten life expectancy;
* treatment with any investigational agent within 1 month before randomization;
* patients already on treatment with n-3 PUFA or statin for whom the prescription is confirmed.

EXCLUSION CRITERIA FOR R2 (statin hypothesis):

* current serum creatinine level \>2.5 mg/dL;
* current ALT, AST level \>1.5 times the upper normal limit;
* current CPK upper normal limits.
C: Inclusion Criteria:

* subjects of both sex, aged of 70 years or over,
* subjects with at least one of the following frailty criteria: a subjective memory complaint, expressed to their attending physician, an inability to perform one of instrumental activities of daily living, a slow walking with a speed ≤ 0.77 m/s, i.e 5 seconds to walk 4 meters.
* subjects with an MMSE score of greater than or equal to 24,
* subjects capable of understanding the protocol, complying with its requirements and attending the study visits,
* subjects with sufficient availability to take part in the multi-domain intervention programme,
* subjects who, in the opinion of the investigator, are liable to comply with the treatment during the study;
* subjects capable of giving their written informed consent
* Covered by a health insurance system

Exclusion Criteria:

* Criteria related to diseases:

  * known presence of dementia or Alzheimer's disease (DSM IV criteria),
  * deterioration in global cognitive function (MMSE \< 24),
  * dependency for basic activities of daily living (ADL\<6),
  * presence of serious diseases, which could be life-threatening in the short term,
  * history or presence of any disease that could compromise the subject's participation in the multi-domain intervention sessions,
* Criteria related to treatments:

  o taking of supplements containing omega-3 (apart from food) within the past 6 months and/or taking omega-3 at inclusion.
* Criteria related to subjects:

  * visual or hearing impairments incompatible with performance and/or interpretation of the neuropsychological tests,
  * history or presence of any previous pathologies that could, in the opinion of the investigator, interfere with the results of the study or expose the subject to an additional risk,
  * subjects deprived of their freedom by administrative or judicial decision, or under guardianship or admitted to a healthcare or social institution,
  * participation in another clinical study in the previous month or participation scheduled during the study.
D: Inclusion Criteria:

* Aged 21 years and older
* Have BMI \>30.0 kg/m2 and \<40 kg/m2
* Willing and able to participate in clinic visits, group sessions, and telephone and Internet communications at specified intervals
* Able to provide data through questionnaires and by telephone
* Willing to maintain contact with the investigators for 12 months
* Willing to allow blood collections
* No known allergy to tree nuts
* Able to be physically active

Exclusion Criteria:

* Diabetic
* Inability to be moderately physically active
* A history or presence of a comorbid diseases for which diet modification and increased physical activity may be contraindicated
* Currently pregnant/breastfeeding
* Planning to become pregnant within the next year
* Currently enrolled in a weight loss program or diet intervention study
* Current use of weight loss medication or supplements
* Planned surgical procedure that can impact the conduct of the study
* Have plans to relocate from area within the next year
* 6+ months use of meds likely to cause weight gain or prevent weight loss
* Any condition which in the opinion of the investigator makes the subject unsuitable for inclusion in this study

Answer: B