International Prevalence, Recognition, and Treatment of Cardiovascular Risk Factors in Outpatients with Atherothrombosis

ORIGINAL CONTRIBUTION

International Prevalence, Recognition, and Treatment of Cardiovascular Risk Factors in Outpatients With Atherothrombosis

Deepak L. Bhatt, MD Context Atherothrombosis is the leading cause of cardiovascular morbidity and mor- P. Gabriel Steg, MD tality around the globe. To date, no single international database has characterized E. Magnus Ohman, MD the atherosclerosis risk factor profile or treatment intensity of individuals with atherothrombosis. Alan T. Hirsch, MD Objective To determine whether atherosclerosis risk factor prevalence and treat- Yasuo Ikeda, MD ment would demonstrate comparable patterns in many countries around the world. Jean-Louis Mas, MD Design, Setting, and Participants The Reduction of Atherothrombosis for Con- Shinya Goto, MD tinued Health (REACH) Registry collected data on atherosclerosis risk factors and treatment. A total of 67 888 patients aged 45 years or older from 5473 physician practices Chiau-Suong Liau, MD, PhD in 44 countries had either established arterial disease (coronary artery disease [CAD], Alain J. Richard, MD, PhD n = 40 258; cerebrovascular disease,n=18843; peripheral arterial disease, n = 8273) Joachim Ro¨ther, MD or 3 or more risk factors for atherothrombosis (n = 12 389) between 2003 and 2004. Peter W. F. Wilson, MD Main Outcome Measures Baseline prevalence of atherosclerosis risk factors, medication use, and degree of risk factor control. for the REACH Registry Investigators Results Atherothrombotic patients throughout the world had similar risk factor profiles: a high proportion with hypertension (81.8%), hypercholesterolemia (72.4%), and ANDOMIZED CONTROLLED diabetes (44.3%). The prevalence of overweight (39.8%), obesity (26.6%), and mor- trials (RCTs) provide the ba- bid obesity (3.6%) were similar in most geographic locales, but was highest in North sis for physicians to practice America (overweight: 37.1%, obese: 36.5%, and morbidly obese: 5.8%; PϽ.001 vs evidence-based medicine and other regions). Patients were generally undertreated with statins (69.4% overall; range: haveR revolutionized the treatment of 56.4% for cerebrovascular disease to 76.2% for CAD), antiplatelet agents (78.6% over- Ն cardiovascular disorders. Due to their all; range: 53.9% for 3 risk factors to 85.6% for CAD), and other evidence-based strict inclusion and exclusion criteria, risk reduction therapies. Current tobacco use in patients with established vascular disease was substantial (14.4%). Undertreated hypertension (50.0% with elevated blood RCTs do not always provide an accu- pressure at baseline), undiagnosed hyperglycemia (4.9%), and impaired fasting glu- rate view of the burden of disease or cose (36.5% in those not known to be diabetic) were common. Among those with long-term prognosis. In contradistinc- symptomatic atherothrombosis, 15.9% had symptomatic polyvascular disease. tion, registries enable a real-world es- Conclusion This large, international, contemporary database shows that classic car- timation of actual disease treatments. diovascular risk factors are consistent and common but are largely undertreated and In the setting of acute coronary syn- undercontrolled in many regions of the world. dromes, several registries have pro- JAMA. 2006;295:180-189 www.jama.com vided insight into real-world event rates, treatment patterns, and outcomes.1-4 care practices. Although several erothrombosis, but it is restricted to The clinical knowledge base regard- advances based on RCTs have been a particular geographic locale and ing acute coronary syndromes is well- made in the management of athero- does not fully address subsequent risk defined, but no comparable interna- thrombosis,5-9 the number of registries Author Affiliations and the REACH Registry Commit- tional data set is available to describe or population-based studies have been tees and National Coordinators are listed at the end the risk profiles and treatment of limited. The Framingham study, for of this article. Corresponding Author: Deepak L. Bhatt, MD, Cleve- individuals with stable atherothrom- example, continues to provide useful land Clinic Foundation, 9500 Euclid Ave, Desk F25, botic disease as defined in primary data on risk factors for developing ath- Cleveland, OH 44195 ([email protected]).

180 JAMA, January 11, 2006—Vol 295, No. 2 (Reprinted) ©2006 American Medical Association. All rights reserved. INTERNATIONAL PREVALENCE AND TREATMENT OF CARDIOVASCULAR RISK FACTORS of patients with established vascular mented CVD consisted of a hospital or gists), health care environments (rural, disease.10,11 neurologist report with the diagnosis suburban, urban), and medical prac- The Reduction of Atherothrombo- of transient ischemic attack or ische- tices (office-based, hospital-based). This sis for Continued Health (REACH) mic stroke. Documented PAD con- selection was designed to try to mimic Registry was initiated to evaluate out- sisted of 1 or both criteria: current the best available epidemiological data patients who would represent the intermittent claudication with ankle- in each country that reflect the bur- entire spectrum of stable atheroscle- brachial index of less than 0.9 or a his- den of atherothrombosis or at-risk rotic clinical syndromes: from those tory of intermittent claudication populations. The national coordina- with risk factors (but who are asymp- together with a previous and related tor in each country made the final de- tomatic) to those with established intervention, such as angioplasty, cision on the selection of physicians and atherosclerotic arterial disease within stenting, atherectomy, peripheral arte- sites in each country. any circulatory bed. The REACH Reg- rial bypass graft, or other vascular Data were collected centrally via use istry was designed to provide these intervention including amputation. of a standardized international case re- data from the most geographically The risk factors consisted of those port form, completed at the study visit. and ethnically diverse population yet that were documented in the medical Baseline height, weight, waist circum- surveyed.12 This article presents the record or for which patients were re- ference, seated systolic and diastolic baseline characteristics of the REACH ceiving treatment at the time of study blood pressure, and available fasting Registry population. enrollment: treated diabetes mellitus, glucose and cholesterol levels were ob- diabetic nephropathy, ankle-brachial in- tained. From these data, baseline demo- METHODS dex of less than 0.9, asymptomatic ca- graphic and risk factor characteristics The REACH Registry is an interna- rotid stenosis of 70% or higher, ca- were analyzed. Body mass index (BMI) tional, prospective, observational regis- rotid intima media thickness of 2 times was defined as weight in kilograms di- try designed to provide up to 24 months or more adjacent sites, systolic blood vided by the square of height in me- of clinical follow-up. The design of the pressure of 150 mm Hg or higher de- ters. Participants were considered to be REACH Registry has been published spite therapy for at least 3 months, hy- overweight if they had a BMI of 25 to elsewhere.12 Briefly, consecutive eli- percholesterolemia treated with medi- less than 30 or obese if they had a BMI gible outpatients aged 45 years or older cation, current smoking of at least 15 of 30 or higher. Obese participants were with established coronary artery dis- cigarettes per day, men aged 65 years further subclassified as having class I ease (CAD), cerebrovascular disease or older, or women aged 70 years or (BMI, 30-Ͻ35), class II (BMI, 35- (CVD), or peripheral arterial disease older. Patients already in a clinical trial, Ͻ40), or class III obesity (BMI Ն40). (PAD), or with at least 3 atherosclero- hospitalized patients, or those who Waist circumference was also used to sis risk factors were enrolled over an ini- might have difficulty returning for a fol- classify patients as obese if it was 40 tial 7-month recruitment period on a low-up visit were excluded from en- inches or larger (Ն102 cm) in men or worldwide basis between December rollment. This protocol was submit- 35 inches or larger (Ն88 cm) in women. 2003 and June 2004; because of regu- ted to the institutional review board in Current smoking was defined as at least latory requirements in Japan, the en- each country according to local require- 5 cigarettes per day on average within rollment in that country was delayed and ments and signed informed consent was the last month before entry into the occurred between August 2004 and De- obtained for all patients. REACH Registry; former smoking was cember 2004. For this reason, and also Selection of physicians to the REACH defined as at least 5 cigarettes per day because of a desire on the part of the Registry was determined at the coun- on average more than 1 month before Japanese REACH investigators to ana- try level. To ensure homogeneity and entry into the REACH Registry. Poly- lyze their data separately, the data from a good representation in the REACH vascular disease was defined as co- Japan were not analyzed together with Registry population, a site selection existent symptomatic (clinically rec- the data from the rest of Asia. Medical method was designed and imple- ognized) arterial disease in 2 or 3 record documentation was required for mented in each participating country territories (coronary, cerebral, and/or establishment of the presence of CAD, by epidemiologists under the supervi- peripheral) within each patient. CVD, or PAD. sion of the REACH Registry global and Family practitioners and general Documented CAD consisted of 1 or local steering committees and na- practitioners (44% of the physicians) more of the following criteria: stable tional coordinators. The site selection as well as other office-based special- angina with documented CAD, history method took into account various and ists in areas such as internal medicine of unstable angina with documented complex criteria such as patient pro- (29%), cardiology (13%), neurology CAD, history of percutaneous coro- files (eg, CAD, CVD, or PAD, or risk (9%), endocrinology (2%), general sur- nary intervention, history of coronary of atherothrombotic events), physi- gery (2%), vascular disease (1%), and artery bypass graft surgery, or previ- cian profiles (eg, general practition- other fields (1%) recruited patients into ous myocardial infarction. Docu- ers, internists, cardiologists, neurolo- the study. Each physician recruited a

©2006 American Medical Association. All rights reserved. (Reprinted) JAMA, January 11, 2006—Vol 295, No. 2 181 INTERNATIONAL PREVALENCE AND TREATMENT OF CARDIOVASCULAR RISK FACTORS maximum of 15 patients (maximum of compare continuous variables. Adjust- tients), Portugal (218 patients), Spain 20 in the United States). ment for age and sex was made by us- (2515 patients), Switzerland (695 pa- In each country, 10% of all sites that ing a multiple logistic model giving the tients), and the United Kingdom (618 enrolled at least 1 patient underwent a least-squares mean of the logit for each patients); Eastern Europe: Bulgaria (996 data audit by completing a site visit. percentage. Statistical significance was patients), Hungary (957 patients), These sites were selected randomly 6% considered as a 2-tailed probability of Lithuania (99 patients), Romania (2009 of the time and an additional 4% were less than .05. Statistical analysis was patients), Russia (999 patients), and selected due to the number of queries performed using SAS software version Ukraine (596 patients); Middle East: Is- and missing data from the site. For each 8 (SAS Institute Inc, Cary, NC). rael (379 patients), Lebanon (120 pa- of the sites (10%) undergoing moni- tients), Saudi Arabia (198 patients), and toring, 100% of case report forms for RESULTS United Arab Emirates (149 patients); patients enrolled at that site were moni- A total of 69 055 patients were en- Asia: China (708 patients), Hong Kong tored for source documentation and ac- rolled in the REACH Registry. Of these, (175 patients), Indonesia (499 pa- curacy. baseline data were available for 67 888; tients), Korea (505 patients), Malay- The sample size for the REACH Reg- 1109 did not meet the inclusion crite- sia (525 patients), the Philippines (1039 istry was estimated as follows. It was as- ria and 58 withdrew their consent. Pa- patients), Singapore (880 patients), Tai- sumed that a minimum of 40 000 in- tients were enrolled from 44 countries wan (1057 patients), and Thailand (515 dividuals would be followed up for an in the following regions: North patients); Japan (5048 patients); and average of 21 months (with Յ30% lost America: Canada (1976 patients) and Australia (2872 patients). The base- to follow-up) with a primary yearly the United States (25 770 patients); line demographics, inclusion criteria event rate of 3% for cardiovascular Latin America: Brazil (441 patients), (CAD, CVD, PAD, or Ն3 risk factors), death, myocardial infarction, or stroke. Chile (253 patients), Mexico (899 pa- and geographic regions are listed in With these assumptions, the preci- tients), and Interlatina (includes Costa TABLE 1 and TABLE 2. sion of the estimate would be 5% Rica, Dominican Republic, Ecuador, The population sample included (range, 2.84%-3.16%). Guatemala, Panama, and Peru: 338 pa- 36.3% women and the mean (SD) age Continuous variables are expressed tients); Western Europe: Austria (1588 was 68.5 (10.1) years (interquartile as mean (SD). Categorical variables are patients), Belgium (383 patients), Den- range, 61-76 years). A high propor- expressed as frequencies and percent- mark (422 patients), Finland (311 pa- tion of patients had diabetes, hyperten- ages. Comparisons between categori- tients), France (4592 patients), Ger- sion, and hypercholesterolemia. There cal variables were performed using the many (5521 patients), Greece (699 were significant differences in the preva- Pearson ␹2 test. The t test was used to patients), the Netherlands (324 pa- lence of risk factors such as diabetes (in

Table 1. Baseline Demographics of Population in the REACH Registry Percentage of Population*

Total Symptomatic CAD CVD PAD Ն3 Risk Factors (N = 67 888)† (n = 55 499) (n = 40 258) (n = 18 843) (n = 8273) (n = 12 389) Age, mean (SD), y 68.5 (10.1) 68.4 (10.1) 68.3 (10.1) 69.4 (10.0) 69.2 (9.8) 69.0 (9.8) Men 63.7 66.9 69.8 59.5 70.7 49.5 Diabetes‡ 44.3 37.5 38.3 37.4 44.2 74.9 Hypertension§ 81.8 80.0 80.3 83.3 81.0 90.3 Hypercholesterolemia 72.4 70.2 77.0 58.2 66.7 82.2 Obesity࿣ 46.6 44.0 45.4 42.6 44.1 58.4 Overweight (BMI, 25-Ͻ30) 39.8 40.9 41.7 39.4 40.3 35.0 Obesity Class I (BMI, 30-Ͻ35) 19.9 18.8 20.3 16.5 17.2 24.8 Class II (BMI, 35-Ͻ40) 6.7 5.8 6.4 4.9 4.6 10.6 Class III (BMI Ն40) 3.6 2.8 3.2 2.3 2.0 7.0 Smoker Former 41.6 44.6 47.1 38.6 50.9 28.4 Current 15.3 14.4 13.0 14.3 24.5 19.2 Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by the square of height in meters); CAD, coronary artery disease; CVD, cerebrovascular disease; PAD, peripheral arterial disease; REACH, Reduction of Atherothrombosis for Continued Health. *Unless otherwise indicated. †Some patients with CAD, CVD, or PAD are listed in 2 or 3 categories and therefore the total of these 3 categories exceeds 67 888. ‡Patients with type 1 or 2 diabetes currently treated with hypoglycemic agents or history of diabetes. §Patients currently treated with medication. ࿣Men: waist circumference of 102 cm or more; women: waist circumference of 88 cm or more.

44.3% of the total population enrolled cose (glucose Ն100 mg/dL [Ն5.55 centage of patients had elevated levels and in 37.5% of symptomatic pa- mmol/L] but Ͻ126 mg/dL [Ͻ6.99 of cholesterol (Ͼ200 mg/dL [5.18 tients) among the different patient sub- mmol/L]) were recorded on the base- mmol/L]), ranging from 24.4% in Aus- groups. There was also marked geo- line visit in a substantial number of pa- tralia to 64.4% in Eastern Europe. Of graphic variation in the prevalence of tients. Overall, 50% of patients had el- the patients with symptomatic athero- diabetes, ranging from 52.5% in the evated blood pressure at baseline. Of thrombosis, a significant proportion Middle East to 27.7% in Eastern Eu- patients with diagnosed hyperten- (15.9%) had symptomatic polyvascu- rope. Current smoking prevalence was sion, baseline blood pressure was lar disease (FIGURE 2). 15.3% overall, although in regions such elevated in 54.9%; of patients without There was a high prevalence of over- as Eastern Europe, current smoking was diagnosed hypertension, baseline weight status and obesity (Table 1 and present in 20.9% (FIGURE 1). blood pressure was elevated in 27.6% Table 2). Overweight and obesity were Documented high blood pressure (PϽ.001). Of patients without diag- prevalent throughout the world, but (systolic Ն140 mm Hg and/or dia- nosed diabetes, fasting hyperglycemia were higher in North America than in stolic Ն90 mm Hg), fasting hypergly- was present in 4.9% and impaired fast- other regions (overweight: 37.1%; obese: cemia (glucose Ն126 mg/dL [Ն6.99 ing glucose was present in 36.5%. In all 36.5%; morbidly obese: 5.8%; PϽ.001 mmol/L]), and impaired fasting glu- geographic regions, a substantial per- vs other regions). Morbid obesity was

Table 2. Baseline Characteristics in the REACH Registry by Geographical Region Percentage of Population*

North Latin Western Eastern Middle America America Europe Europe East Asia Australia Japan Symptomatic No. of patients 20 750 1681 15 053 5375 718 5137 2567 4218 Age, mean (SD), y 70.1 (10.3) 67.2 (10.2) 68.3 (9.6) 63.2 (9.3) 66.1 (10.5) 64.7 (9.7) 72.8 (9.1) 69.7 (8.4) Men 61.6 65.0 72.1 66.6 73.7 67.0 66.3 73.8 Diabetes† 42.9 38.1 34.0 25.7 49.1 41.2 25.0 38.5 Hypertension† 84.2 77.4 77.7 85.2 80.6 79.9 75.5 70.5 Hypercholesterolemia† 82.2 59.6 72.1 50.8 80.7 56.2 78.3 44.6 Obesity†‡ 51.5 41.9 50.3 46.7 45.9 17.9 55.6 8.8 Overweight (BMI, 25-Ͻ30)† 38.4 47.7 47.8 48.0 47.8 35.5 44.3 29.5 Obesity† Class I (BMI, 30-Ͻ35) 25.0 15.7 19.8 19.7 19.9 5.9 22.1 3.4 Class II (BMI, 35-Ͻ40) 9.4 3.4 4.5 3.5 5.5 0.7 6.1 0.2 Class III (BMI Ն40) 5.1 0.9 1.0 0.7 1.5 0.3 2.2 0.1 Smoker† Former 48.3 44.0 45.0 30.4 29.4 29.8 55.7 46.6 Current 13.0 6.2 13.9 14.1 10.4 8.4 6.8 14.7 Ն3 Risk Factors Only No. of patients 6996 250 2833 281 128 766 305 830 Age, mean (SD), y 69.1 (10.3) 66.2 (10.5) 69.3 (9.1) 65.0 (9.9) 67.7 (10.5) 66.9 (9.5) 72.8 (6.9) 70.3 (7.8) Men 47.0 40.7 56.2 44.1 61.4 49.9 55.1 48.7 Diabetes† 76.6 80.4 70.0 53.4 70.7 86.6 84.1 86.8 Hypertension† 92.7 89.2 91.6 94.0 94.3 87.7 82.5 73.0 Hypercholesterolemia† 88.5 70.9 77.1 68.2 86.7 76.9 93.6 64.8 Obesity†‡ 65.0 63.9 67.7 57.7 65.8 23.6 71.0 17.0 Overweight (BMI, 25-Ͻ30)† 33.0 48.7 41.5 44.7 44.2 36.3 34.8 32.5 Obesity† Class I (BMI, 30-Ͻ35) 29.6 22.4 29.2 22.0 27.8 8.2 31.1 6.0 Class II (BMI, 35-Ͻ40) 13.4 7.5 8.8 7.1 4.2 1.5 16.0 0.5 Class III (BMI Ն40) 8.3 3.0 3.2 0.6 1.3 0.5 3.4 0.2 Smoker† Former 30.4 24.0 24.3 15.9 20.1 14.2 34.2 19.3 Current 14.9 10.5 19.0 23.1 14.5 12.2 14.7 26.3 Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by the square of height in meters); REACH, Reduction of Atherothrombosis for Continued Health. *Unless otherwise indicated. PϽ.001 for all comparisons. †Adjusted for age and sex. ‡Men: waist circumference of 102 cm or more; women: waist circumference of 88 cm or more.

Figure 1. Undertreatment of Risk Factors in Patients Worldwide

Elevated Blood Pressure Elevated Cholesterol Current Smoking ≥ > ≥ No. of ( 140/90 mm Hg) ( 200 mg/dL) ( 5 Cigarettes/d) Geographic Region Patients North America 27 746 Latin America 1 931 Western Europe 17 886 Eastern Europe 5656 Middle East 846 Asia 5903 Australia 2872 Japan 5048

0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70 Patients, % Patients, % Patients, %

To convert cholesterol to mmol/L, multiply by 0.0259.

COMMENT Figure 2. Prevalence of Polyvascular Disease in the REACH Registry Evidence-based medicine holds the Percentage Single Arterial Bed promise to improve patient care glob- Overall 65.9 ally. Based on RCTs, practice care CAD Alone 44.6 guidelines have been developed and are CVD Alone 16.6 being implemented throughout the PAD Alone 4.7 world.13 The REACH Registry demon- Polyvascular Disease Overall 15.9 strates a substantial gap between rec- CAD + CVD 8.4 ommendations in guidelines and ac- CAD + PAD 4.7 tual clinical practice in the care of CVD + PAD 1.2 patients with or at risk for atherothrom- CAD + CVD + PAD 1.6 bosis. A pattern of underutilization of

Multiple Risk Factors 18.3 established medical therapies and lifestyle interventions is seen in the 0 10 20 30 40 50 60 70 REACH Registry throughout all geo- Patients, % graphic regions studied, among differ- CAD indicates coronary artery disease; CVD, cerebrovascular disease; PAD, peripheral arterial disease; REACH, ent physician specialties, and across dis- Reduction of Atherothrombosis for Continued Health. ease subtypes. Despite an overwhelming amount of data in support of statins and most prevalent in North America sified as not obese with both criteria. antiplatelet therapy, these classes of (Table 2). The prevalence of obesity as Medications used are listed by ath- medicines are not being prescribed at determined by BMI correlated with obe- erosclerosis risk factor prevalence optimal rates. A substantial propor- sity as defined by elevated waist circum- (TABLE 3) and geographic region tion of patients receiving statins are not ference (␬ Cohen coefficient, 0.48; 95% (TABLE 4). Of the total population, meeting established targets that are rec- confidence interval [CI], 0.48-0.49; 78.6% were receiving some form of an- ommended in guidelines for choles- PϽ.001), although a substantial pro- tiplatelet therapy and 69.4% were re- terol reduction,14,15 and newer data sug- portion of patients categorized as obese ceiving statins. Medication use varied gest even more aggressive targets.16,17 by one measure were not classified as based on geography; for example, statin Only a minority of patients were at tar- obese by another measure; 29.9% were use was lowest in Japan. However, get goals for blood pressure, glucose, obese as assessed by BMI, while 46.5% across geographic regions, the propor- cholesterol, body weight, and nonuse were obese by waist circumference. Ad- tion of patients meeting established cho- of tobacco. ditionally, 25.6% of the patients were lesterol targets was suboptimal. There Risk factors present in patients with classified as obese with both criteria, was also substantial variation in pa- CAD, CVD, or PAD were observed to 20.8% were classified as obese with waist tients’ medication use by physician spe- be remarkably consistent across vas- circumference but not with BMI; con- cialty (TABLE 5). For example, cardi- cular beds and across geographic re- versely, 4.3% were classified as obese ologists prescribed acetylsalicylic acid gions in the REACH Registry. This lat- with BMI but not with waist circumfer- and statins significantly more often than ter observation is consistent with global ence and 49.2% of the patients were clas- other physician specialties. observations in survivors of myocar-

184 JAMA, January 11, 2006—Vol 295, No. 2 (Reprinted) ©2006 American Medical Association. All rights reserved. INTERNATIONAL PREVALENCE AND TREATMENT OF CARDIOVASCULAR RISK FACTORS dial infarction in the INTERHEART prove the treatment of risk factors, such atherothrombosis on morbidity and study.18 Overall, these findings high- as by implementing care pathways mortality.22-24 light the importance of treating the core and measuring adherence to guide- Another interesting observation set of risk factors (hypertension, dia- lines.1,20,21 about obesity in the REACH Registry betes, hypercholesterolemia, tobacco Obesity has been identified as a ma- has to do with the definitions used. As use, and obesity) that appear to con- jor public health concern and the defined by BMI, 30% of patients in this tribute to the bulk of the risk for de- REACH Registry baseline data con- study population would be defined as veloping atherothrombosis.18 Treat- firm the prevalence of obesity through- obese. Alternatively, when obesity was ing such factors more aggressively to out the world. The rates in North defined by waist circumference, al- reach established goals would de- America are particularly alarming and most half of the patients were catego- crease the need for subsequent revas- should serve as a signal to the rest of rized as obese. Because more than cularization procedures. To date, no the world, especially to areas where 62 000 patients had a baseline waist cir- trial has demonstrated that revascular- urbanization and industrialization are cumference measurement, the fol- ization is superior to medical therapy occurring, which may expose popula- low-up phase of the REACH Registry in reducing mortality in patients with tions that are particularly genetic- should enable a comparison of these stable CAD.19 Therefore, it becomes ally susceptible to atherothrombosis 2 metrics of obesity.25-28 Furthermore, even more important to find ways to im- and further accelerate the impact of the thresholds at which obesity is linked

Table 3. Medication Use Among Patients in the REACH Registry by Atherosclerosis Risk Factor Prevalence Percentage of Population*

Total CAD CVD PAD Ն3 Risk Factors (N = 67 888) (n = 40 258) (n = 18 843) (n = 8273) (n = 12 389) No. of patients with diagnosed hypertension 58 920 34 127 16 741 7302 11 536 or elevated blood pressure at initial examination At least 1 antihypertensive 95.8 97.4 94.1 92.4 96.7 ␤-Blockers 48.9 63.3 38.7 42.9 30.6 ACE inhibitors 48.2 50.7 46.7 47.2† 47.4† Diuretics 44.0 44.5‡ 42.3 46.4 49.7 Calcium channel blockers 37.2 36.2 39.8 39.9 37.3† Angiotensin II receptor blockers 25.4 22.6 24.5‡ 23.2 34.0 Other antihypertensives 10.6 10.1 11.6 11.5‡ 12.4 Antiplatelet therapy At least 1 antiplatelet agent 78.6 85.6 81.8 81.7 53.9 Acetylsalicylic acid 67.4 76.2 62.1 62.5 49.8 Other antiplatelet agents 24.7 26.1 36.5 34.5 6.3 Any 2 antiplatelet agents 13.2 16.6 16.6 14.9 2.1 No. of patients with history of diabetes 31 424 16 314 7499 3814 9401 or elevated blood glucose at initial examination At least 1 diabetes medication 85.9 82.5 82.2 85.6† 93.6 Sulfonylureas 42.7 40.1 41.2‡ 36.4 47.8 Biguanides 40.0 35.6 34.1 31.0 50.6 Insulin 25.7 27.7 25.0† 37.8 22.9 Thiazolidinediones 17.1 15.3 13.2 13.2 23.4 Other diabetes medications 10.9 9.7 10.5† 9.8‡ 12.8 Nitrates 24.2 38.0 18.4 23.4‡ 3.1 NSAIDs 11.7 11.2 10.6 10.9‡ 15.6 Lipid-lowering therapy At least 1 agent 75.2 80.9 61.3 70.0 81.3 Statin 69.4 76.2 56.4 64.2 71.6 Other lipid-lowering agents 12.0 12.2† 9.0 11.5† 16.1 No. of patients with PAD 8273 4298 1907 8273 0 Cilostazol, pentoxifylline, buflomedil, or naftidrofuryl 28.7 25.9 29.0† 28.7 0 Abbreviations: ACE, angiotensin-converting enzyme; CAD, coronary artery disease; CVD, cerebrovascular disease; NSAIDs, nonsteroidal anti-inflammatory drugs; PAD, peripheral arterial disease; REACH, Reduction of Atherothrombosis for Continued Health. *Unless otherwise indicated. PϽ.001 for all comparisons except as marked below. †P value not significant (Ն.05). ‡P value significant at Ͻ.05 but Ͼ.001.

©2006 American Medical Association. All rights reserved. (Reprinted) JAMA, January 11, 2006—Vol 295, No. 2 185 INTERNATIONAL PREVALENCE AND TREATMENT OF CARDIOVASCULAR RISK FACTORS to increased cardiovascular risk may of overlap in the involvement of influence of recruitment biases (which vary across populations.29-32 The different arterial circulations would be may vary geographically) cannot be REACH Registry may allow examina- even greater than seen in the present known. Physicians were instructed to tion of the appropriate thresholds for analysis. recruit consecutive patients, but un- obesity in different national or ethnic There are several limitations to this like in an RCT, there were no log books populations.29-32 analysis. While the REACH Registry is audited to ensure compliance with such In patients with established athero- more geographically diverse than other instructions. Despite efforts to ensure thrombosis, symptomatic polyvascu- registries that have examined popula- the inclusion of representative pa- lar disease was common in the REACH tions with stable cardiovascular dis- tients from every participating coun- Registry. One of 6 patients with CAD, ease, this study does not include im- try, this study has limitations inherent CVD, or PAD had symptomatic involve- portant geographic regions and ethnic to nonpopulation-based registries. We ment of 1 or 2 other arterial beds. This groups (ie, the underrepresentation of were not able to determine if undocu- finding points to the diffuse nature African and Chinese populations, mented contraindications to medica- of atherothrombosis and implies that among many). By focusing on stable tions or economic limitations affected atherothrombosis is best treated as a outpatients, the enrolled patients may the lack of medication use. However, systemic disease.33 Of course, if the be at a lower risk than if inpatients with the magnitude of underrecognition and degree of asymptomatic polyvascular atherothrombotic diseases had also undertreatment of atherothrombosis disease was examined, the degree been included. As for all registries, the risk factors is such that this finding is

Table 4. Medication Use Among Patients in the REACH Registry by Geographical Regions Percentage of Population*

North Latin Western Eastern Middle America America Europe Europe East Asia Australia Japan (n = 27 746) (n = 1931) (n = 17 886) (n = 5656) (n = 846) (n = 5903) (n = 2872) (n = 5048) No. of patients with diagnosed hypertension 24 713 1595 15 478 4962 714 5028 2494 3936 or elevated blood pressure at initial examination At least 1 antihypertensive 97.5 94.7 94.7 97.5 98.0 95.4 93.1 89.1 ␤-Blockers 51.8 40.3 51.4 63.0 60.3 41.7 39.3 20.0 ACE inhibitors 49.5 47.0 48.9 77.0 56.4 34.3 45.1 20.2 Diuretics 51.4 40.2 46.2 51.0 44.8 25.6 29.9 13.7 Calcium channel blockers 35.7 35.0 33.3 29.7 42.0 44.6 32.7 65.2 Angiotensin II receptor blockers 27.6 25.9 23.8 4.1 21.1 31.0 25.4 37.7 Other antihypertensives 12.5 5.6 10.2 9.1 14.1 9.5 9.2 5.9 Antiplatelet therapy At least 1 antiplatelet agent 77.0 87.3 78.1 86.4 90.8 81.6 74.5 74.3 Acetylsalicylic acid 71.3 77.0 62.3 75.1 83.7 63.4 64.3 54.8 Other antiplatelet agents 20.1 30.7 27.3 26.1 25.2 30.7 19.7 32.1 Any 2 antiplatelet agents 14.3 20.5 11.0 14.7 18.0 12.4 9.5 12.6 No. of patients with history of diabetes 14 740 888 7345 1660 469 2982 907 2433 or elevated blood glucose at initial examination At least 1 diabetes medication 87.1 91.2 85.6 79.5 87.4 88.2 84.7 78.9 Sulfonylureas 43.3 48.7 35.8 37.4 49.2 56.6 39.9 44.3 Biguanides 41.8 45.6 39.9 30.9 54.3 49.8 55.5 13.1 Insulin 26.9 23.6 30.1 22.3 23.4 15.4 21.3 23.6 Thiazolidinediones 30.1 7.1 4.9 1.6 5.7 10.4 2.1 6.3 Other diabetes medications 7.8 8.5 11.4 10.8 7.4 13.9 1.8 27.9 Nitrates 18.9 16.8 23.7 42.4 31.4 28.0 31.6 27.2 NSAIDs 18.3 6.0 7.6 4.5 8.1 4.2 23.3 3.0 Lipid-lowering therapy At least 1 agent 83.6 68.5 75.2 62.3 85.1 66.6 80.2 51.4 Statin 76.9 64.2 69.9 57.6 82.4 60.5 78.8 44.6 Other lipid-lowering agents 18.1 10.0 7.8 7.0 7.5 9.2 2.5 10.0 No. of patients with PAD 2545 223 3550 710 56 319 260 610 Cilostazol, pentoxifylline, buflomedil, or naftidrofuryl 23.6 29.2 28.3 57.9 40.7 26.8 0.4 29.2 Abbreviations: ACE, angiotensin-converting enzyme; NSAIDs, nonsteroidal anti-inflammatory drugs; PAD, peripheral arterial disease; REACH, Reduction of Atherothrombosis for Continued Health. *Unless otherwise indicated. PϽ.001 for all comparisons.

186 JAMA, January 11, 2006—Vol 295, No. 2 (Reprinted) ©2006 American Medical Association. All rights reserved. INTERNATIONAL PREVALENCE AND TREATMENT OF CARDIOVASCULAR RISK FACTORS likely to be robust. Furthermore, phy- erosclerosis risk factors, albeit with The percentages of overweight and sicians deciding to participate in a re- some significant international vari- obese patients support efforts at tar- search initiative such as the REACH ability. These data demonstrate a geting this risk factor in patients Registry may have been more apt to pro- strikingly elevated degree of obesity along the atherothrombotic con- vide better care and therefore the find- internationally as a critical cardiovas- tinuum of risk. The follow-up phase ings of undertreatment may reflect a cular risk factor. Despite a high preva- of the REACH Registry will allow best-case scenario and actually under- lence of many risk factors, systematic measurement of the cardiovascular estimate the true degree of undertreat- undertreatment is evident throughout ischemic event rates of this popula- ment in general clinical practice. the regions studied. The prevalence of tion as well as an assessment of how In conclusion, data from this large, polyvascular disease in the patients these various risk factors affect the international, contemporary registry with symptomatic atherothrombosis rate of subsequent morbidity and demonstrate that patients with mani- substantiates the cross-risk that mortality and cardiovascular out- fest atherothrombosis or those at risk patients face in arterial beds other comes in a geographically diverse are characterized by the common ath- than in their initial presenting one. population.

Table 5. Medication Use Among Patients in the REACH Registry by Physician Specialty Patient Population by Physician Specialty, %*

General Vascular Practice Internist Cardiologist Angiologist Surgeon Neurologist Endocrinologist Other (n = 27 392) (n = 20 998) (n = 8442) (n = 629) (n = 1037) (n = 5376) (n = 1535) (n = 393) No. of physicians in specialty 2124 1631 765 81 126 533 166 47 No. of patients with diagnosed 23 750 18 775 6753 534 891 4703 1358 367 hypertension or elevated blood pressure at initial examination At least 1 antihypertensive 95.5 97.3 98.1 81.8 83.3 91.7 97.5 97.0 ␤-Blockers 44.9 52.9 70.1 34.1 34.2 32.1 43.0 47.5 ACE inhibitors 46.1 50.4 54.6 40.6 36.1 47.5 50.6 46.7 Diuretics 43.6 49.1 41.1 31.3 30.1 33.8 47.6 52.9 Calcium channel blockers 38.7 36.6 34.7 33.5 31.2 33.1 37.6 42.9 Angiotensin II receptor blockers 26.8 27.2 20.8 19.9 13.3 15.5 33.6 26.3 Other antihypertensives 10.3 11.7 8.4 10.6 10.7 9.9 11.1 14.7 Antiplatelet therapy At least 1 antiplatelet agent 74.8 78.4 89.5 80.0 84.6 85.0 71.0 72.6 Acetylsalicylic acid 63.8 69.0 80.3 59.2 64.4 62.8 63.2 64.6 Other antiplatelet agents 22.1 22.8 29.8 29.1 32.1 38.5 14.9 20.6 Any 2 antiplatelet agents 10.8 13.3 20.4 7.5 11.3 15.9 7.0 12.6 Anticoagulants 12.6 13.1 11.0 10.6 9.8 11.9 8.0 11.9 No. of patients with history of diabetes 12 918 10 326 2930 198 447 1819 1423 216 or elevated blood glucose at initial examination At least 1 diabetes medication 86.1 86.2 82.0 83.3 87.6 81.1 97.7 87.4 Sulfonylureas 43.0 42.6 43.9 35.0 36.3 41.1 46.6 35.4 Biguanides 42.1 38.9 37.0 36.4 35.1 37.0 51.0 34.1 Insulin 24.0 27.1 20.2 31.1 36.7 18.2 46.8 37.1 Thiazolidinediones 17.4 21.2 9.2 5.2 2.5 3.8 18.8 27.5 Other diabetes medications 11.6 10.3 9.6 7.9 7.3 9.9 10.6 7.9 Nitrates 23.4 23.4 36.8 14.1 18.7 16.9 15.3 21.4 NSAIDs 14.2 13.2 5.2 3.6 6.3 5.6 7.6 7.7 Lipid-lowering therapy At least 1 lipid-lowering agent 75.9 79.2 83.2 63.2 53.0 49.5 81.9 69.2 Statin 69.4 73.5 79.1 54.5 49.2 45.2 74.0 64.1 Other lipid-lowering agents 12.4 13.6 10.3 13.4 5.6 6.0 16.3 12.9 No. of patients with PAD 3256 2562 525 406 745 350 124 55 Cilostazol, pentoxifylline, buflomedil, 28.4 28.2 24.1 35.6 31.5 33.1 32.5 13.5 or naftidrofuryl Abbreviations: ACE, angiotensin-converting enzyme; NSAIDs, nonsteroidal anti-inflammatory drugs; PAD, peripheral arterial disease; REACH, Reduction of Atherothrombosis for Con- tinued Health. *Unless otherwise indicated. PϽ.001 for all comparisons.

Author Affiliations: Department of Cardiovascular wan University Hospital and College of Medicine, Tai- demiology and Community Health, University of Medicine, Cleveland Clinic Foundation, Cleveland, pei; Jean-Louis Mas, MD, Centre Raymond Garcin, Minnesota School of Public Health, Minneapolis. Ohio (Dr Bhatt); Departement de Cardiologie, Hoˆpi- Paris, France; E. Magnus Ohman, MD, Duke Univer- A list of the REACH Registry Investigators is on jama tal Bichat-Claude Bernard, Paris, France (Dr Steg); Di- sity Medical Center, Durham, NC; Joachim Ro¨ ther, MD, .com. vision of Cardiology, Duke University, Durham, NC Klinikum Minden, Minden, Germany; P. Gabriel Steg, Acknowledgment: We acknowledge Veronique Da- (Dr Ohman); Minneapolis Heart Institute Founda- MD, Hoˆ pital Bichat-Claude Bernard, Paris, France (co- clin, MD, and Luc Sagnard, MD, of Sanofi-Aventis and tion and Division of Epidemiology and Community chair); Peter W. F. Wilson, MD, Medical University of Brian Gavin, PhD, of Bristol-Myers Squibb for their sup- Health, University of Minnesota School of Public South Carolina, Charleston. port of the REACH Registry and Craig Balog, BS, of Health, Minneapolis (Dr Hirsch); Division of Hema- National Coordinators: Australia: Christopher Reid, the Cleveland Clinic Foundation for statistical sup- tology, Keio University School of Medicine, Tokyo, Ja- Monash University, Victoria. Austria: Franz Aichner, port. Mr Balog did not receive any direct compensa- pan (Dr Ikeda); Service de Neurologie, Centre Ray- Landes-Nervenklinik Wagner-Jauregg, Linz; Thomas tion for the analyses he performed; however, the Cleve- mond Garcin, Hoˆ pital Sainte-Anne, Paris, France (Dr Wascher, Medizinische Universita¨ tsklinik, Graz. Bel- land Clinic Cardiovascular Coordinating Center did Mas); Department of Medicine, Tokai University School gium: Patrice Laloux, Cliniques Universitaires UCL, receive a grant for statistical support from the indus- of Medicine, Kanagawa, Japan (Dr Goto); Depart- Mont-Godinne. Brazil: Denilson Campos de Albu- try sponsors of the REACH Registry. ment of Internal Medicine, National Taiwan Univer- querque, State University of Rio de Janeiro, Rio de Ja- sity Hospital and School of Medicine, Taipei, Taiwan neiro. Bulgaria: Julia Djorgova, University Hospital St (Dr Liau); Global Medical Affairs–Clinical Opera- Ekaterina, Sofia. Canada: Eric A. Cohen, Sunnybrook REFERENCES tions, Sanofi-Aventis, Paris, France (Dr Richard); De- & Women’s College Health Sciences Centre, Univer- partment of Neurology, Klinikum Minden, Minden, sity of Toronto, Toronto, Ontario. Chile: Ramon Cor- 1. Bhatt DL, Roe MT, Peterson ED, et al. 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Hungary: Gyo¨ rgy Pfliegler, University of Debrecen meta-analysis of randomised trials of antiplatelet therapy Administrative, technical, or material support: Bhatt, Medical and Health Science Center, Institute of Medi- for prevention of death, myocardial infarction, and stroke Steg, Ro¨ ther, Wilson. cine, Division of Rare Disease, Debrecen. Indonesia: in high risk patients. BMJ. 2002;324:71-86. Study supervision: Bhatt, Steg, Hirsch, Mas, Ro¨ ther, Bambang Sutrisna, University of Indonesia, Jakarta. 6. US Preventive Services Task Force. Aspirin for the Wilson. Israel: Avi Porath, Soroka Medical Center, Beer Sheva. primary prevention of cardiovascular events: recom- Financial Disclosures: Dr Bhatt has received hono- Japan: Yasuo Ikeda, Keio University School of Medi- mendation and rationale. Ann Intern Med. 2002;136: raria from Bristol-Myers Squibb and Sanofi-Aventis. cine, Tokyo. Lebanon: Ismail Khalil, American Univer- 157-160. Dr Steg has received honoraria from Bristol-Myers sity Hospital Hamra, Beirut. Lithuania: Ruta Babar- 7. Heart Protection Study Investigators. MRC/BHF Squibb and Sanofi-Aventis and research grants from skiene, University Hospital, Kaunas. Malaysia: Heart Protection Study of cholesterol lowering with Sanofi-Aventis. Dr Ohman has received research grants Robaayah Zambahari, Institut Jantung Negara, Kuala simvastatin in 20,536 high-risk individuals: a ran- from Sanofi-Aventis. Dr Hirsch has received research Lumpur. Mexico: Efrain Gaxiola, Instituto Cardiovas- domised placebo-controlled trial. Lancet. 2002;360: grants from Bristol-Myers Squibb and Sanofi- cular de Guadalajara, Jalisco. the Netherlands: Don Pol- 7-22. Aventis; honoraria from Sanofi-Aventis; and has served dermans, Erasmus Medisch Centrum, Rotterdam. Phil- 8. CAPRIE Steering Committee. A randomised, blinded, on the speakers bureau for Sanofi-Aventis. None of ippines: M. Teresa B. Abola, Philippine Heart Center, trial of clopidogrel versus aspirin in patients at risk of the other authors reported disclosures. Quezon City. Portugal: Victor Gil, Hospital Fernando ischaemic events (CAPRIE). Lancet. 1996;348:1329- Funding/Support: The REACH Registry is sponsored Fonseca, Amadora. Romania: Constantin Popa, Insti- 1339. by Sanofi-Aventis, Bristol-Myers Squibb, and the Waks- tutul de Boli Cerebro-Vasculare, Bucharest. Russia: Yuri 9. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Da- man Foundation (Tokyo, Japan). Belenkov, Cardiology Research Complex, Moscow; genais G; Heart Outcomes Prevention Evaluation Study Role of the Sponsors: All manuscripts in the REACH Elizaveta Panchenko, Cardiology Research Complex, Investigators. Effects of an angiotensin-converting- Registry are prepared by independent authors who are Moscow. Saudi Arabia: Hassan Chamsi-Pasha, King enzyme inhibitor, ramipril, on cardiovascular events not governed by the funding sponsors and are re- Fahd Military Hospital, Jeddah. Singapore: Yeo Tiong in high-risk patients. N Engl J Med. 2000;342:145-153. viewed by an academic publications committee be- Cheng, National University Hospital, Singapore. South 10. Wilson PW. Framingham and European risk al- fore submission. The funding sponsors have the op- Korea: Oh Dong-Joo, Korea Hospital, Seoul. Spain: gorithms: implications for African Americans. Rev Car- portunity to review manuscript submissions but do not Carmen Sua´ rez, Internal Medicine, Hospital Univer- diovasc Med. 2004;5(suppl 3):S34-S41. have authority to change any aspect of a manuscript. sitario de la Princesa, Madrid. Switzerland: Iris 11. Liu J, Hong Y, D’Agostino RB Sr, et al. Predictive REACH Registry Executive Committee: Deepak L. Baumgartner, Universita¨ tspital Bern, Klinik und Po- value for the Chinese population of the Framingham Bhatt, MD, Cleveland Clinic Foundation, Cleveland, liklinik fu¨ r Angiologie, Bern. Taiwan: Chiau-Suong Liau, CHD risk assessment tool compared with the Chi- Ohio (cochair); E. Magnus Ohman, MD, Duke Uni- National Taiwan University Hospital, Taipei. Thai- nese Multi-Provincial Cohort Study. JAMA. 2004;291: versity Medical Center, Durham, NC; Joachim Ro¨ ther, land: Piyamitr Sritara, Ramathibodi Hospital, Bangkok. 2591-2599. MD, Klinikum Minden, Minden, Germany; P. Gabriel United Arab Emirates: Wael Mahameed, Al Jazeera 12. Ohman EM, Bhatt DL, Wilson PWF, Ro¨ ther J, Steg Steg, MD, Hoˆ pital Bichat-Claude Bernard, Paris, France Hospital, Abu Dhabi. United Kingdom: Jonathan Mor- PG; for REACH Registry Investigators. The REACH Reg- (cochair); Peter W. F. Wilson, MD, Medical Univer- rell, the Conquest Hospital, St Leonards-on-Sea, Hast- istry: an international, prospective, observational in- sity of South Carolina, Charleston. ings, England. Ukraine: Vira Tseluyko, Kharkov Medi- vestigation in subjects at risk of atherothrombotic REACH Registry Publication Committee: Deepak L. cal Academy of Postgraduate Education, Kharkov. events—study design. Am Heart J. In press. Bhatt, MD, Cleveland Clinic Foundation, Cleveland, United States: Mark Alberts, Northwestern Univer- 13. Braunwald E, Antman EM, Beasley JW, et al. ACC/ Ohio (cochair); Shinya Goto, MD, Tokai University sity Medical Center, Chicago, Ill; Robert M. Califf, Duke AHA 2002 guideline update for the management of School of Medicine, Isehara, Kanagawa, Japan; Alan University Medical Center, Durham, NC; Chris- patients with unstable angina and non-ST-segment T. Hirsch, MD, Minneapolis Heart Institute Founda- topher P. 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People who develop the habit of thinking of them- selves as world citizens are fulfilling the first require- ment of sanity in our time....More and more, the choice for the world’s people is between becoming world warriors or world citizens. —Norman Cousins (1915-1990)

REACH Registry Investigators son, Mark Thompson, Siobhan Tiernan, David Tillett, Azul, Marcos Tambascia, Se´ rgio Xavier, Fabio Yama- Australia: Heidi Andersen-Dalheim, Paul Anderson, Bill Simon Tong, Henry Tran, Ha Tran, Tuan Tran, Ivan moto, Winston Yoshida, Maria Tereza Zanella. Anell, Sam Arber, Kathleen Armstrong, Dean Arnot, Treagus, Ching Tang Tsiang, Trenna Turner, Edwin Bulgaria: Maria Alexandrova, Vesselina Andonova, Og- Alan Baldam, Ian Barratt, Sebastian Barresi, Jeff Be- Turner, John van Bavel, Christopher Verrall, Robert nian Assenov, Penka Atanassova, Valentina Baleva, der, Michael Benson, Frederick Bergman, James Best, Vorich, Hugh Wall, William Walton, Gary Ward, Bruce Haralambi Benov, Vera Bogdanova, Valentin Bonev, Rajesh Bhasim, Geoff Bovell, Neil Bowman, Mal Brkic, Wauchope, Cole Weatherall, Peter Wexler, Andrew Nikolay Botushanov, Tihomir Daskalov, Alexander David Bromberger, David Brown, Jean Brown, Mi- White, Gabrielle Wiehle, Robert Wight, Ian Williams, Daskalov, Ivan Deltchev, Stefan Denchev, Simeon chael Brownstein, Angela Bruce, John Buonopane, Martin Williams, Stephen Williams, Frank Wilson, Pe- Dimitrov, Miroslav Dimitrov, Bojidar Dimov, Temenuca Steven Burns, Alexis Butler, Danny Byrne, Judith Car- ter Winterton, Steven Wong, Richard Wrennall, Joan Donova, Todor Draganov, Assen Dramov, Elisaveta son, Peter Cassimatis, Greig Chaffey, Dianne Cham- Yat, Michael Yelland, Gordon Yip, Nathan Zhou, Mi- Enicheynova, Bojidar Finkov, Krassimir Genov, Stef- bers, Wing-Jung Chan, Ben Chan, James Cheatham, chael Ziccone, Barbara Zochowski. ko Georgiev, Svetoslav Georgiev, Zhaneta Georgieva- Rachel Chen, Brian Cheong, Christina Cheung, John Austria: Charles Allen, Gerald Andracher, Marcus At- Tyaneva, Mariana Gospodinova, Valentina Grigor- Chin, Anthony Chiu, Eric Choo, Andrew Chow, Anna teneder, Gabriela Barbieri, Johannes Brandstetter, Chris- ova, Erna Hadjolian, Varbitza Hergeldjieva, Eva Hrant, Marie Chow, Dara Chung, Michael Conos, Nicholas tian Bsteh, Heinz Peter Deiser, Alexander Doder, Wolf- Lilia Ivanova, Sonya Ivanova Hristova, Darina Kaneva, Cooke, Simon Cooper, Peter Coulton, Mariam Cran- gang Eckert, Astrid Fahrleitner-Pammer, Walter Fiala, Zdravko Karagiozov, Sonya Karakaneva-Cholakova, swick, Garth Crichton, Adrian Dabscheck, Jonothan Lothar Fiedler, Florian Fiedler, Wolfgang Filip, Jo- Marko Klissurski, Rumen Kolarov, Mariana Konteva, Dalitz, Jammal Danishar, Andris Darzins, Deborah Dav- hannes Fo¨ chterle, Karl Forstner, Karl Freynhofer, Stoyan Lekushev, Detelina Loukanova, Ani Madja- idson, Paul Davis, Norfreet Dawood, Maxwell de Clif- Thomas Frieden, Engelbert Fru¨ hwirth, Alfons Gegen- rov, Ivan Manchev, Zdravka Maslarska, Haygushi Ma- ford, Fred de Looze, Antonio de Sousa, Santhramani huber, Alfred Gewessler, Herbert Goldsteiner, Man- tosyan-Bogdanova, Georgi Mazhdrakov, Teodina Devi, John Dickman, Hillary Donald, Barry Dowell, Ka- fred Grisold, Franz Gruber, Wolfgang Gspandl, Wal- Micheva, Mihail Mihailov, Ivan Milanov, Ivo Milyo- trina Dowey, Peter Eizenberg, Claire Eizenberg, Lili- ter Hauer, Michael Herg, Jakob Herk, Gu¨ nter Heyer, tev, Evdokia Naidenova, Valcho Naydenov, Eugeni ana Elberg, Peter Enten, Adolf Erhardt, Roger Fagan, Horst Hiemetzberger, Wolfgang Hof, Johann Hohe- Nedialkov, Galina Nikolova, Mariana Panova, Si- David Fairweather, Noni Ferguson, Peter Ferguson, necker, Franz Hohensinn, Thomas Honsig, Gerhard mona Panteleeva, Zoritza Papazian, Vasilka Pasheva, Colin Fernando, Michael Ferres, Peter Foley, Sonnie Huber, Heinz Hutter, Gabriele Iampaglia-Springer, Karl Atanas Peltekov, Atanas Penev, Stanislav Petranov, Fong, Peter Francis, Doron Gaddie, Brad Gallagher, Itzlroither, Kurt Jenny, Elisabeth Jenull, Michael Jung, Ivo Petrov, Julia Petrova, Elena Petrova, Arman Post- Robert Gan, Jon Garland, Andrew Gault, Nick Gi- Karl Jungbauer, Raimund Kaserbacher, Reinhold Kat- adjian, Ivo Raychev, Nizar Rifai, Ira Rousseva, Ni- anarakis, David Gibson, Ian Gill, Michael Giltrap, Rob- zenschlager, Josef Kimeswenger, Ernst Kittler, Ger- kolay Runev, Rumen Runkov, Veselin Rusinov, Penko ert Gingold, Neil Gordon, Margaret Graham, Murray hard Kitzler, Martin Koschutnik, Harald Kotzmann, Shotekov, Nina Simeonova, Diana Smilkova, Ivan Stai- Grave, James Grigg, Lynn Hall, Merilie Hall, Kerry Han- Wolfgang Krasselt, Manfred Kuhler, Bernhard Ku- kov, Elena Staikova, Paraskeva Stamenova, Kra- cock, Colin Harrison, Richard Harrison, Rodney Hayden, nauer, Herwig Kunczicky, Susanne Kurzemann, Paul simira Stankova, Georgi Stefanov, Varban Stoyanov, Judith Heale, Prue Healy, Eva Herold, Elaine Hirst, Ste- Lachner, Walter Lux, Thomas Maca, Bernhard Mayer, Vassil Stoyanovsky, Velislava Teneva, Snezhanka Ti- phen Hodby, Chris Hogan, Peter Horsfall, Allan Regina Mika, Beate Mo¨ rz, Heidemarie Mu¨ ller-Ringl, sheva, Latchezar Traykov, Diana Trendafilova- Hutchinson, Chia Irmgard, Suresh Jain, Duncan Jef- Helmut Nimmerfall, Walter Nowotny, Helmut Ort- Lazarova, Margarita Tsolova, Galina Tsonevska, Maria ferson, Richard John, Therese John, Brendan Kay, Pa- ner, Dieter Pa¨ tzold, Thomas Perger, Friedrich Pe- Tzekova, Moris Tzolov, Liliana Valcheva, Elisaveta Val- tricia Kelly, Darren Kester, John Khury, John Kirmos, tuely, Peter Pichler, Kurt Pinter, Johann Pollak, Harald cheva, Roumyana Valtcheva, Euguenia Vassileva, Va- Susan Kloot, Danielle Kolos, Jacqueline Korner, Colin Pressl, Susanne Pusarnig, Kveta Pusch, Momen Radi, sil Velchev, Tzetza Velkova, Maria Vlahova, Stefka Kratzing, Jana Kubicek, Ashok Kumar, Clive Lacey, Con Manfred Rausch, Siegfried Reisenbichler, Reinald Riedl, Yancheva, Zahari Zahariev, Vladimir Zhelev. Lahanis, Daniel Lajoie, Loi Lam, Maryanne Lan- Heinz Sattler, Ju¨ rgen Schatz, Peter Scheibner, Hans Canada: Alnoor Abdulla, Glenn Andrea, Catherine An- caster, Henry Law, Carolyn Lawlor-Smith, Richard Lay- Schimbach, Christof Schmidauer, Dieter Schmidt, Hel- drew, Guy April, Jeff Ashley, Richard Audet, Ramesh cock, Ivan Lee, Conway Leung, Leon Levitt, Leon Lewi, mut Schossleitner, Martin Schumacher, Josef Schu¨t- Avinashi, John Axler, Carolyn Baer, Allan Bailey, Greg James Liew, Stephen Liew, David Lleweslyn, Peter Loth, zenberger, Hans Schwaiger, Hans Peter Seit, Gabri- Banta, Alan Bell, Ira Bernstein, Claude Be´ rube´ , Pierre Eldon Lyon, Shane Maclaren, Clare Maher, Frank ele Sepp, Gerhard Stadlbauer, Erwin Hans Steiner, Franz Bolduc, Jean Bouthillier, Teresa Bree, Gerald Brown, Maldari, John Manderson, Linda Mann, Muhammed Stradner, Walter Streichsbier, Andreas Stummer, An- David Caplan, John Chan, William Chan, Chris Chan, Abdul Mannan, Frank Marano, Damian Marinucci, dreas Stu¨ mpflen, Ursula Teleky, Kurt Tiesenhausen, Richard Chen, James Cherry, John Chiu, Kenneth Cho, Anne Matthews, Clare Matthews, Rebecca McGowan, Raffi Topakian, Hermann Toplak, Manfred Tu¨ rkis, Betty Choi-Fung, Guy Chouinard, Anthony Cia- Larry McGrath, John McKenna, Elizabeth Wolfgang Unterberger, Elisabeth Wais, Heribert Wait- varella, Christian Constance, James Robin Conway, McNaughton, Margaret McNiff, John Meaney, John zer, Alois Waschnig, Harald Waxenegger, Wolfgang Mario Coˆte´ , Ronald Cox, Gordon Crelinsten, Marie- Menzies, Anthony Michaelson, Samir Michail, Geoff Friedrich Weber, Manfred Weindl, Wolfgang Werner, Jose´ e Cucuzza, Mehboob Damji, John Paul de Young, Mitchell, Rohan Molenaar, Paul Molloy, Elena Monaco- Eugen Zadra, Elisabeth Zaruba, Wolfgang Ziegel- Langis Dionne, Frank Doane, Jean Duckett, Sylvie Mugliston, Clare Mooney, Michael Moor, Brian meyer, Klaus Zitt. Emond, Sherali Esmail, Alan Faiers, Donald Fay, Linda Moylan, Vajira Nanayakkara, Peter Nathan, Wendy Belgium: Serge Blecic, Youssef Bouhdid, Patricia Cham- Ferguson, Murdo Ferguson, Gilles Gaudreau, Caro- Naughton, Robert Ng, Ken Nicholson, Murray Nixon, pagne, Willy Coenegrachts, Patrick Cras, Jean-Marie line Geenen, Jean-Paul Gendron, Peter Giannoccaro, Geoff Nuendorf, Chris O’Brien, Paul O’Hanlon, James Dalcq, Eric Decock, Antonio Di Mascio, Luc Dieudonne´, Jean Godbout, Yolanda Gonzalez, Shaun Goodman, Olesen, Andrew Ong, Say Gark Ong, Michael O’Toole, Robert Dobbelaere, Stephanie Duhoux, Benoit Fes- Krishnasamy Govender, Pierre Goyer, Vojtech Gre- Michael Page, Peter Pahuja, Hugh Palmer, Stephen ler, Alain Friart, Louis Gallez, Jean Marie Jaumotte, San- gus, Jeff Habert, Nader Habib, Sam Henein, Robert J. Parker, Stephanie Partridge, Helen Patroney, John Pat- drine Jeangette, Jean-Michel Knop, Robert Leuridan, Herman, James Hii, Michael Hill, Hanna M. Hinnawi, tison, Gary Pellizzari, Anna Marie Perlesz, David Phill- Niels Libbrecht, Jean-Marie Massart, Guido Mehuys, Ralph Hollands, Tommy Hong, Blair Hrabarchuk, Pe- ips, Alian Phillips, John Philpot, Leon Piterman, Jock Jean-Marie Merlin, Serge Motte, Muriel Sprynger, ter Hum, Shiraz Ismail, Naaz Jaffer, Amir Janmo- Plenderleith, Harry Preston, Mark Preston, Chris- Justina Surma, Vincent Thijs, John Thoeng, Francois hamed, Allan Kelly, Anne Kenshole, Brian Kessel, Jack topher Priest, Andy Psaradellis, Warner Quarles, Mi- Vanholsbeeck, Geert Vanhooren, Joseph Varga, Frank Kooy, Gilles Lafrance, Sheung-Ying Lam, Daniel Lan- chael Quinn, Jennifer Randle, Colette Reeves, Tam- Vermassen, Marc Vermeulen. dry, Clement Lang, Luc Lanthier, Christian Lauriston, sin Rhodes, Frank Rhodes, Nigel Rosen, Jaqueline Brazil: Luiz Ataı´de Junior, Jacob Atie, A´ lvaro Ave- Claude Lauzon, Denis Lavigueur, Alex Leung, Wil- Rounsevell, Warwick Rouse, Ernest Rozsa, Indrani Sa- zum, Francisco Bandeira, Luiz Bodanese, Antonio Bra- liam Lipsett, Bruce Lubelsky, Lawrence Luftspring, Rob- haray, Joseph Sakowsky, Mahinda Samararatna, Neil sileiro, Antonio Carlos Carvalho, Roberto Esporcatte, ert Luton, Patrick Ma, Ariane Mackey, David Marsh, Same, Victor Sammut, Les Sands, David Schepisi, Derek Jose´Pe´ ricles Esteves, Angela Maria Eugeˆ nio, Gilson Jean Marie Martel, Altaf Mawji, Pravinsagar Mehta, Scurry, John See, Jan Sheringham, Keith Shing, Henry Feitosa, Jefferson Fernandes, Alfredo Halpern, Cı´- Kenneth Melvin, Karim Merali, Pierre Meunier, Jef- Simmons, Hira Singh, Lynette Skardoon, David Slonim, cero Lopes, Ruy Lyra, Nilton Machado, Le´ a Maciel, frey Meyerson, Marie-Jose´ Miron, Karl Misik, Peter Jane Smith, Stuart Smith, Geoff Spurling, Stephen Roberto Marino, Ayrton Massaro, Ame´ lio Matos, Evan- Mitha, David Morgenthau, Rolf-Dieter Neu, Phuong Stowe, Violetta Stoyanova, Subbaram Sundar, Hed- dro Mesquita, Maria Moreira, Yosio Nagato, Jose´ Car- B. Nguyen, Amarjit Nirwan, Claire Nunes-Vaz, Ed- ley Sutcliffe, Ian Sutherland, Pauline Swan, Jane Tam, los Nicolau, Paulo Roberto Nogueira, Antonio Pazin ward Nykiforuk, William O’Mahony, Michael Omichin- Mary Tapsall, Patrick Teh, Stan Theodoros, Susan Filho, Marco Tulio Pires, Antonio Rocha, Ricardo Ro- ski, Marc Paquin, Kalpana Patel, Rajni Patel, Pierre Thomas, Jon Thomas, Karen Thompson, David Thomp- cha, Jose´ Francisco Saraiva, Helena Schmid, Joa˜ o Serro Payer, Allen Payne, Keyvan Pazuki, Ismail Peer, Claude

Phaneuf, Gilles Plamondon, Henryk Pluta, Kent Pottle, Berto, David Berville, Philippe Bessette, Thierry Betta, belle Gaudisart-Amblard, Bruno Gauthier, Philippe Gay, Jim Price, Ann Rebane, Thomas Rebane, Claude Rob- Gilles Bindler, Guy Birry, Olivier Bisch, Michel Bis- Dominique Genoud, Bernard Geoffray, Philippe Ger- erge, Gerald Rockman, David Rosenberg, Wendy muth, Philippe Blanc-Vannet, Pascal Blouin, Henri Boc- main, Olivier Geronimi, Luc Gilles, Henri Gin, Pierre Rosenthall, Julie Ross, Howard Rudner, Salwa Saad, calon, Pierre Jean Bodiou, Thierry Boely, Eric Boely, Ginestet, Jean Paul Giorgi, Charles Giraldi, Christian Kevin Saunders, Georgia Savvidou, Nawal Sharma, Georges Boitelle, Thierry Bontemps, Claude Borto- Girard, Michel Gissler, Vincent Gleye, Isabelle Glo- Wojciech Sobkowski, Eric St-Amour, Brian Strom, Jack lotti, Delphine Bortolotti, Gerard Bosselut, Marc Bouche, rieux, Laurent Goepfert, Marie Chantal Gournay- Sussman, Christine Szparaga, Paul Talbot, Prafull- Philippe Bouche, Henri Bouchetoux, Philippe Bou- Lahoussine, Paul Gouron, Michaela Grabovescu, Phil- chandra A. Talwalkar, Lyne The´ riault, Graham Tur- langer, Amina Bourahoui, Michel Bourgoin, Francois ippe Grange, Serge Michel Gran-Ortiz, Jean-Paul pie, Felix Veloso, George Vertes, Jean Villeneuve, Boutelier, Eric Boutfol, Philippe Boyer, Pierre Boyer, Grazzini, Dominique Grevet, Bruno Grivet, Francois Trevor Vu, Michael Weinstock, Rosemary White, Agnes Brachet, Olivier Brafman, Rene Brassac, Nico- Grivet, Remy Groell, Marc Grohar, Gilles Grollier, Pierre Danny Wong, Wilfred Wong, Daniel Yim, David Yip, las Breton, Isabelle Bringer-Raingeard, Jean Brous- Gros, Bernard Gros, Sabine Grutter, Gerard Gui- Linda Yolles, Bruce Zimmermann. saud, Francoise Broutin, Claude Brunaud, Philippe Bru- chard, Robert Guilharretze, Herve Guillaumot, Daniel Chile: Monica Acevedo, Fernando Araya, Nelson Bar- neau, Olivier Brunet, Daniel Buchon, Philippe Buffler, Guillemot, Claude Haller, Claudine Hamel-Desnos, Ed- rientos, Victor Bianchi, Eduardo Chavez, Rienzi Diaz, Jean Cabane, Didier Cadinot, Andreia Calmeiro, Alain ward Hannoush, Michel Harroch, Jean-Claude Haus, Humberto Dighero, Jorge Gajardo, Bernardita Gara- Campagnac, Jerome Campagnac, Thierry Canali, Ma- Manuela Hebert, Eric Helms, Marc Hemocq, Frederic yar, Berta Garrido, Vicente Gutierrez, Arnold Hoppe, rie Elizabeth Cano, Pascal Canu, Dominique Capar- Henriot, Bruno Henry, Marc Herent, Robert Hertling, Ronald Kauffmann, Albrecht Kramer, Sonia Kunst- ros, Cyril Cardon, Muriel Carlotti, Francois Carniaux, Philippe Hild, Christine Hild, Hassan Hosseini, Jean mann, Leopoldo Manriquez, Eliana Srur, Jorge Tapia, Pascale Carre, Michel Casanova, Isabelle Casanova, Claude Hourcq, Jean-Luc Hovine, Jean-Louis Huber- Paola Varleta, Raul Villar. Bruno Casedevant, Marc Castaner, Jacqueline Cas- schwiller, Remi Huet, Dominique Huet, Thierry Hum- China: Nai Sheng Cai, Shi Ping Cao, Sheng Di Chen, tany, Benoit Cauchy, Pierre Causse, Christine Cavat, bert, Didier Ihli, Jean-Louis Iriart, Yves Jacamon, Sophie Jilin Chen, Xiaoping Chen, Yan Cheng, Li Ying Cui, Philippe Cayron, Marie Anne Cazale-Richier, Chris- Jacqueminet, Valerie Jacques, Cecile Jacquet, Jean- Qing Di, Xin Sheng Ding, Zhi Min Du, Wei Fan, Jian tian Cazals, Christophe Cazard, Bruno Ceccarelli, Pierre Pierre Jacquet, Alain Jacquot, Jean Francois Jamet, Do- Hui Fu, Lu Yue Gai, Wei Gao, Guo Xiang He, Chang Cerda, Christine Cerna, Pierre Chabreron, Patrick Cha- minique Jamilloux, Lise Jappy, Pierre Jaudon, Fran- Lin Hu, Yi Ning Huang, Shu Wei Huang, Quan Yue laux, Alain Chaleon, Alain Chalvignac, Raymond Chap- coise Jean, Georges Jean, Frederic Jeanjean, Claude Huang, Dexin Jin, Wei Li, Jin Li, Chun Jian Li, Zhu Yi eron, Pierrick Chaplin, Stephane Chapuis, Laurent Char- Jedynak, Franck Jonot, Eric Jordan, Thierry Joseph, Li, Jian Wen Lin, Ming Ya Liu, Xin Feng Liu, Ming Liu, bonnel, Pascal Charbonnel, Marie Francoise Chatelet, Christine Jouin, Pierre Jourdan, Jean-Thierry Jusserand, Ben Yan Luo, Lei Lv, Ai Qun Ma, Ling Miao, Huan Christian Chauvois, Michel Chay, Patrick Chemouni, Edmond Kaltenbach, Anne Kerharo-Nicolas, Abbes Chun Ni, Guozhong Niu, Guo Guang Peng, Chuan Chabane Cherbi, Jean Marie Chevalier, Jean- Khennouf, Catherine Kleimberg, Didier Kleimberg, Qiang Pu, Pei Li Pu, Guo Xian Qi, Ming Li Rao, Jie Francois Cheynel, Bernard Chiausa, Remi Choussat, Pierre Kohser, Arnaud Koubbi, Michel Krempf, Pierre Song, Shui Jiang Song, Xiao Jiang Sun, Qing Ling Tao, Michel Chretien, Isabelle Cibois-Honnorat, Luc Cimino, Kuhn, Christophe Kurtz, Francois Lacoin, Valerie La- Ji Jun Teng, Zheng Wan, Shao Shi Wang, Wei Qing Serge Cini, Christian Claudel, Yvon Claudel, Gerard grange, Stephane Lahoussine, Patrick Lambert, Jean- Wang, Yongjun Wang, De Xin Wang, Jian-An Wang, Codron, Thierry Coeure, Monique Cohen, Samuel Co- Michel Lamperin, Georges Lanusse-Cazale, Christine Wei Wang, Li Juan Wang, Jia Ping Wei, Shao Xiang hen, Jean-Philippe Cohen-Bacry, Felix Cohen-Seban, Largillier, Daniel Lascaux, Robert Latour, Jean- Weng, Zhong Gui Wu, Shi Yao Wu, Chen Bin Wu, Marie-Pierre Coispeau, Herve Colin, Jean Philippe Col- Michel Lauer, Dominique Lauga, Francis Laulhe, Bo Xiao, Feng Xu, Yun Xu, Xiao Wel Yan, Bo Yu, Huai let, Anne Colobert, Robert Combet, Philippe Con- Jacques Launay, Marie-Paule Laur, Bruno Laureille, Phil- Qin Zhagn, Feng Ru Zhang, Bao Wei Zhang, Yong chonnet, Claude Conri, Bernard Coppe, Claudine ippe Laurent, Francoise Laurent-Montero, Philippa La- Zhang, Sheng Nian Zhou, Ying Ling Zhou, Jianhua Zhu. Cordier, Francis Coriol, Isabelle Coriol, Vanessa Corre, vallee, Marie-Catherine Lavigne, Claude Le Deve- Denmark: Erik Agner, Gudrun Boysen, Ole David- Stephane Cosson, Alain Costargent, Marc Cothenet, hat, Rapharel Le Diagon, Jacques Le Du, Stephane Le sen, Birger Engby, Jens Jorgen Frifeldt, Per Fruer- Jean-Francois Cottencin, Yves Cottin, Gilles Coudert, Mouel, Dominique Lecaignard, Christophe Lecarme, gaard, Karin Geisler, Gyllich Gulliksen, Allan K. Han- Jean-Pierre Courreges, Bertrand Cuisinier, Em- Florence Leclercq, Victor Lecue, Francois Ledru, De- sen, Palle Holck, Helle K. Iversen, Nils Johannesen, Ole manuel Custoza, Laurence Dages, Simon Dahan, Pa- nis Lefort, Christian Legrand, Anne-Marie Leguer- Kahr, Anders Kastrup, Jens Ole Kjærgaard, Ib Chris- trick Dary, Christophe Daumas, Marie-Laure Dau- rier, Jacques Lelgouarch, Laurent Lemaire, Maurice Le- tian Klausen, Mads Lessing, Per Lund, Henrik Mad- mas, Michel David, Alain de Almeida, Antoine de maire, Patrice Lemaire, Bruno Lemarie, Bernard sen, Allan McNair, Per Meden, Hans Michley, Hans Guibert, Emmanuel de Joux, Bernard de la Grand- Lemettre, Philippe Lemoine, Michel Lenormand, Jean- Mickley, Torben Munck Mortensen, Walter Nielsen, ville, Erik de Mautort, Etienne de Saint-Martin, Joelle Luc Lepoutre, Bernard Lerich, Jean-Michel Lerouge, Mogens Odde Kjær, Morteza Oskoie, Jan Petersen, Debout, Olivier Decloux, Francoise Defrance, Freder- Monique Lescoute-Jabot, Pierre-Yves Letellier, Jean- Tina Poulsen, Niels Ralfkiær, Frode K Rømer, Mette ick Defreyn, Maryse Degeilh, Edith Delan, Thierry De- Marie Letzelter, Michel Leveque, Marc Levy, Ber- Sondergaard, Troels Sorensen, Niels Svaneborg, Chris- landre, Irene Delbachian, Alain Delcros, Dominique nard Levy-Casson, Pierre Leygnac, Jean-Paul Lhos- tian Tuxen, Anette Wildschødtz Hansen, Birgit Wolff. Delefosse, Christian Delplace, Bruno Dely, Jean- mot, Francois Liard, Alain Lion, Jean Locquet, Jean- Finland: Voitto Aittola, Juha-Pekka Era¨ linna, Ville Ha¨ ll- Claude Deme, Marie-Helene Demortiere, Paul De- Francois Loewert, Boris Lormeau, Jacques Louis, Alain berg, Veli-Pekka Harjola, Heikki Huikuri, Raimo Hyt- neuville, Michel Depoisier, Gerard Depret-Bixio, Max Louison, Pascale Louveau, Michel Louy, Gerard Lus- tinen, Rainer Icen, Timo Ikonen, Timo Kaitila, Juhani Derochet, Sylvie Descombes, Jean-Pierre Des- siana, Pascal Mabire, Yvan Machero, Francisco Macian- Karmakoski, Sirkka Keina¨ nen-Kiukaanniemi, Raimo granges, Pascal Dessales-Quentin, Jacques Dewulf, Ber- Montoro, Christian Magnaval, Patricia Magnus, Mar- Kettunen, Paula Kohonen-Jalonen, Juhani Koistinen, nard Dimon, Patrick Doat, Jean-Philippe Doazan, Jean- tine Maillan-Martin, Philippe Mainetti, Christian Pa¨ ivi Korhonen, Petri Korkeila, Ilkka Kuisma, Mikko Yves Doerr, Andre Domenech, Valerie Domigo, Erwan Mallemont, Philippe Mallet, Patrice Manigold, Phil- Laaksonen, John Melin, Markku Nissila¨ , Jorma Ohisalo, Donal, Catherine Dormard, Bernard Doucet, Domi- ippe Marchand, David Marciano, Jean-Louis Mar- Osmo Pammo, Juha Puranen, Mikael Railo, Arto Ran- nique Dreux, Bruno Dubedout, Jean-Christophe Du- ger, Bernard Marino, Philippe Marissal, Philippe Mar- tala, Marja Repo-Outakoski, Erkki Sa¨ko¨ , Olli Sal- carme, Gerard Duclos, Gerard Dugny, Philippe Du- tial, Remy Martin, Jacques Martin, Michel Martin- linen, Arto Strandberg, Sakari Sulosaari, Jyrki Taurio, mond, Thierry Dunand, Pierre Dupouy, Jean Pierre Peridier, Helder Martins, Gregoire Martocq, Jean- Marja-Leena Tuominen, Antti Virkama¨ki. Dupre, Olivier Dupuy, Thierry Durantel, Jean Fran- Jacques Masson, Isabelle Mathys, Yves Maupin, Daniel France: Leila Abdi-Kriaa, Nathan Abenhaim, Philippe cois Durbiano, Patrice Dutilleul, Marc Duval, Louis Du- Maury, Antoine Medvedowsky, Patrick Meimoun, Yves Aerts, Laurent Aigle, Jean-Paul Albert, Alain Albouy, vochel, Verena Eckert, Dominique Edet, Jean-Michel Mercey, Alain Mercier, Christian Meresse, Patrick Mess- Anfari Ali-Mirode, Jacques Allix, Marc Amendola, Ehrlich, Pierre Eisele, Chantal Elbhar-Pouchoue, Brig- ner, Marianne Metivier, Bruno Meyrand, Jerome Me- Gerard Amigues, Hafid Amougay, Pascale Anderson, itte Escourrou, Pierre Espinasse, Jean-Christophe Eti- zin, Bozena Michalak, Christian Michel, Philippe Pierre Andreani, Claude Antoine, Claude Arnold, Michel enne, Joel Etienney, Francois-Xavier Eveillard, Domi- Michellier, Didier Milhaud, Mohamed Mohsen, Jean- Arnould, Marie-Anne Arrondel, Pierre Attali, Ray- nique Eveno, Christian Fabregue, Salam Farhat, Corinne Francois Molinier, Michel Molinier, Gerard Mollet, Jean mond Attuil, Pierre Aubois, Michel Aucouturier, Mo- Fauchard-Renard, Veronique Fauchier, Sandrine Fa- Molleville, Paul Monsegur, Frederic Montloin, Raphael nique Audibert, Patrick Audouy, Christian Auge, Jean vre, Patrick Fayard, Israel Feldmann, Dominique Felten, Moreno, Didier Moritz, Paul Morvan, Jean Mottin, Rene Auriault, Jean-Luc Azoulay, Philippe Bachongy, Pascal Ferchaud, Daniel Feret, Nicole Ferreira- Betty Mougenot-Pierson, Herve Moura, Pierre Mours, Georges Badoc, Michel Baehrel, Christophe Baer, Oli- Maldent, Renaud Ferrier, Jean Ferrieres, Jean Feuil- Pascal Moussu, Patrick Moutier, Mahmoud Mteirek, vier Baissas, Youssef Barada, Marc Baragnon, Charles let, Christian Fivel, Christelle Fleury, Michel Flizot, Marc Jean-Joseph Muller, Eric Nabedian, Jonas Naybodo- Baranes, Marianne Barbellion, Guy Barberet, Alain Bar- Flosi, Eric Foltzer, Xavier Fontaine, Remi Fonteny, Ber- kama, Jean-Philippe Neau, Marc Nejman, Jacques Ner- doux, Jacques Bargier, Antoine Bariaud, Claude Barj- trand Forestier, Michel Forne, Andre Fortis, Chris- son, Pierre Nevians, Bruno N’guyen, Jean-Luc Nico- houx, Fabrice Baron, Denis Baron, Stephane Bartoli, tiane Fouillat, Bruno Fouillen, Yves Foure, Pierre deme, Luc Niel, Elisabeth Nivelleau, Richard Noel, Jean- Philippe Bayle, Charles Beck, Christian Bell, Olivier Fournier, Jean-Claude Fournillou, Marc Franchet, Agnes Claude Nusimovici, Desire Obadia, Thierry Oger, Alain Benais, Herve Benichou, Jean-Louis Bensoussan, Vin- Francillotti, Christian Francois, Magali Frayssinhes, Jean- Olive, Charles Olivier, Pierre-Louis Olland, Daniele cent Benvenuto, Philippe Berdague, Patricia Bernet- Luc Gabrielli, Pierre Galy, Jerome Garnier, Pierre Gar- Orenstein, Alain Outteryck, Jean-Marie Pabst, Didier Bernady, Jean-Marc Bernier, Gilles Berrut, Nathalie nier, Eric Garnier, Eric Garrel, Christian Gasior, Isa- Pachod, Eric Page, Francois Paillard, Jean-Eric Panac-

E2 JAMA, January 11, 2006—Vol 295, No. 2 (Reprinted) ©2006 American Medical Association. All rights reserved. REACH REGISTRY INVESTIGATORS ciulli, Didier Paneau, Claude Paradis, Daniel Parent, Bodenschatz, Michael Bo¨ gel, Jan-Peter Bohe, Gu¨ nter Uwe Meier, Stefan Meier, Eveline Meinecke, Uwe Mei- Marc Paris, Christian Pellenc, Alfred Penfornis, Charles Bo¨ hm, Jo¨rgBo¨ hme, Christina Bondke, Andreas Bonen- nung, Eckhardt Meisel, Michael Meibner, Ulricke Mer- Antoine Percheron, Gerard Perez, Antonia Perez- kamp, Snezana Booz, Andreas Bo¨ rgmann, Rudolf bach, Harald Messner, Friedrich H. Methfessel, Bernd Martin, Beatrice Perin, Dominique Pernin, Philippe Per- Brachmann, Bernadette Brado, Hans-Joachim Braun, Metscher, Horst Meub, Brigitte Meyer-Bender, Ludger reur, Eric Perrier, Bernard Perrin, Jean-Louis Perrotel, Ralf-Markus Braun, Heinz Hubert Breuer, Stefan Brock- Micke, Andreas Mietaschk, Wolfgang Mohr, Sieg- Michel Perrousse, Valerie Perroux, Laurent Petit, Ol- mann, Friedrich Bro¨ er, Berthold Bronder, Gabriela fried Moltzahn, Christina Mondorf, Roland Morell, ivier Petit, Jerome Peyraud, Jean-Michel Philipp, Fre- Bru¨ ck, Heribert Bru¨ ck, Claudia Bru¨ ckmann-Stautner, Margarethe Moritz-Lippmeyer, Walter Mu¨ ller, Uwe deric Philippeau, Yves Picard, Jean-Francois Piera, Marc Christoph Bru¨ ckner, Stephan Brune, Petra Buchholz, Mu¨ ller-Bu¨ hl, Roman Mura, Ronald Naumann, Karl- Pieretti, Joel Pierini, Eddie Pierre-Justin, Philippe Pi- Rudolf Buchkremer, Karsten Bunge, Udo Burczyk, Heinz Nedder, Andrea Neeff, Peter Nehrig, Alya Neu, etri, Denis Pinaud, Jean-Francois Pinel, Guillaume Pinel, Gudrun Burgei-Seifert, Hans-Martin Busch, Lutz Busch- Eberhard Neumann, R. Manfred Neumann, Hans- Francois-Xavier Pinson, Christophe Piot, Marc Ant- mann, Ulrich Butz, Andreas-Christoph Cebulski, Rainer Peter Nikolaus, Lennhart Nissen, Ru¨ diger Nold, Ralf oine Pistorius, Michele Pithon, Anni Pithon, Pascal Plan, Clob, Klaus Coppenrath, Dominik Cornely, Richard Oertel, Helmut Ofer, Rainer Offermann, Gu¨ nter Opel, Jean-Noel Poggi, Philippe Poinot, Patrick Poisson, Alan Daikeler, Jens Daniel, Andreas Daxer, Walter Deeg, Thomas Opitz, Bernd Ostmann, Peter-Michael Poquet, Yvon-Yann Pouedras, Francoise Pouedras- Heinz Degering, Christian Delank, Karsten Diehls, Fred Pankow, Ru¨ diger Patschan, Andreas Pa¨ tz, Albrecht Raton, Michel Pouget, Jacques Pourcin, Regis Pradeau, Dobiasch, Martin Dobner, Adel Doumit, Christoph Pellens, Roswitha Perlwitz, Karl-Heinz Pfetsch, Horst Jacques Prat, Christiane Prat-Caillol, Thierry Prieur, Ber- Drechsler, Rainer Dresler, Holmer Drews, Karsten Philippi, Nicola Piepenbrock, Joachim Pinterowitsch, nard Prijac, Jean-Michel Proville, Alain Pucheu, Jean- Droese, Jens Drummer, Regina Drzymalla, Joachim Ba¨ rbel Pohle, Axel Poll, Christian Pomiersky, Bettina Bernard Pueyo, Charles-Philippe Puiggali, Francis Pu- Dubowy, Martin Du¨ rsch, Frank Dusold, Klaus Ebel- Poten, Ernst Prange, Annegret Preissner-Kiebling, jol, Jacques Quadrelli, Alain Queguiner, Isabelle Quere, ing, Hans-Holger Ebert, Dietmar Eckert, Verena Eck- Horst-Dieter Pu¨ ls, Peter Puth, Rainer Pu¨ ttbach, Hol- Fabrice Quilliou, Anne Quiqempois-Kaminski, Fran- ert, Rolf Eichner, Josef El Shamsy, Nicole Eltges, Erich ger Pu¨ tz, Rita Quosigk, Hubert Raab, Rami Raba- cois Rabut, Sanae Rahili-Polette, Jacques Rambaud, Emde, Peter Engeser, Aman Esmaty, Hannelore Ex- hieh, Reinhard Raddant, Friedrich Ramm, Gu¨ nther Pascal Raucourt, Sylvie Ravel, Philippe Ravoire, Serge ner, Ulrich Faber, Herbert Facius, Dirk Falkenhahn, Rapp, Klaus P. Ratzmann, Michael Rau, Wolfgang Rebiere, Serge Rebmann, Jerome Regnier, Marie- Thomas Feldmann, Gottfried Fiala, Andreas Fiedler, Rautenberg, Thomas Reiff, Norbert Reike, Bernd Di- Therese Reichard, Jean-Francois Reinard, Pierre Reins, Manfred Finck, Jo¨ rg Finkenthei, Herbert Fissan, Ul- eter Reinhard, Albert Reischl, Ute Rentz, Andreas Reul, Adrien Remacle, Jean-Jacques Remerieras, Jean- rich Fleischer, Klaus Flohr, Dirke Franke, Heidrun Eberhard Rieker, Stefan Ries, Volker Rink, Claus Eric Francois Renucci, Jean-Luc Reny, Yves Resslen, Georges Franke, Robert Franz, Frank Franzmann, Udo Frees, Rippl, Ulrich Rissel, Ulf Ritter, Silke Ro¨ hl, Hartmut Reumont, Jean-Luc Reynier, Christel Riera, Jean- Michael Freimuth, Dierk Freundl, Ansgar Frieling, Bar- Rohlfing, Monika Ro¨ hrich, Anette Rosenthal, Verena Francois Rietsch, Marc Ripoll, Patrick Ritz, Jean- bara Froehlich, Anja Fro¨ hlich, Michael Frommhold, Hel- Roth, Michael Roth, Ursula Rotsel-Scha¨ fer, Martin Rot- Pierre Robert, Jean Robert, Dominique Robert, Fran- mut Garten, Jenny Ga¨ rtner, Uwe Gerbaulet, Andreas tenberger, Klaus Rudolph, Hermann Ruider, Dieter cois Robin, Christian Roche, Gilles Rodier, Jean- Gerhardt, Thomas Gerlach, Walter Glaser, Heinz Ruland, Heidrun Rupp, Johannes Ru¨ ter, Verena Ru¨ th- Jacques Roger, J. Francois Rolland, Eric Romen, Jean- Glomm, Ju¨ rgen Glo¨ s, Ulrich Godt, Gholamreza lein, Anita Sach, Ali Safavi, Peter Sagemu¨ ller, Uwe Luc Rondeau, Gilles Ronziere, Andre Roques, Sophie Goudarzi, Oliver Grams, Klaus-Dieter Greie, Andreas Sakrib, Arshad Sayegh, Thomas Scha¨ fer, Helmut Schar- Rosenberg, Frederic Rosier, Eugenio Rosset, Eric Grosschaedl, Josef Grobkopf, Ludwig K. J. Gru¨ n, Ek- rel, Gottfried Schellenberg, Wulf Schenk, Oliver Rouchaud, Camelia Roudiere, Ronan Roussel, Aime kehard Gru¨ tzner, Hans-Georg Grzeschik, Joachim Haaf, Schiffmann, Josef Schimek, Karola Schladitz, Ju¨ rgen Rousset, Gerard Rouviere, Marcel Ruetsch, Marc Rui- Maria Haas-Weber, Gerold Hadlich, Klaus Hafender, Schlegl, Matthias Schlick, Hans-Joachim Schlu¨ ter, Gab- vard, Didier Sacareau, Jean-Francois Sagez, Domi- Andreas Hagenow, Wolfgang Hahn, Dieter Hailer, Mi- riele Schlu¨ ter-Block, Gu¨ nther Schmid, Sebastian nique Saillard, Patrick Salerno, Antoine Salloum, Mar- chael Hammerl, Ulrich Hanselle, Sabine Hansen, Mi- Schmidtke, Kerstin Schmiedeberg, Georg Schneider, tin Salzmann, Jacques Samat, Nabil Saouma, Herve chael Hardt, Ralf Hauer, Liane Hauk-Westerhoff, Ernst Klaus Schnittert, Michael Schnittert, Norbert Scho¨ ll, Sarfati, Jean-Pascal Sastourne, Jean-Louis Saunier, Alain Richard Hauser, Jan-Pieter Hecht, Christoph U. Hedt- Matthias Scholz, Dirk Scho¨ n, Norbert Scho¨ n, Sabine Saurat, Desire Savoyen, Christian Scellier, Christian kamp, Voker Hefftler, Diethard Heimann, Thomas Scho¨ ne, Wolfgang Scho¨ necker, Joachim Scho¨ nen, Schaal, Pierre Schatzkine, Andre Schmitt, Christian Heinl, Ullus Heinrich, Gerd-Ulrich Heinz, Susann Henke, Thomas Scho¨ nfelder, Eleonore Scho¨ nrock, Matthias Schnebelen, Raymond Schordan, Katia Schroeder, Yves Wolfgang Hentrich, Harald Herber, Ju¨ rgen Herbers, Schreiner, Mark Schreiner, Johannes Schriek, Thomas Schultz, Rodolphe Schwab, Christophe Seinturier, Syl- Heinz Herbst, Georg Herman, Peter Hertzer, Wolf- Schro¨ der, Bernd Schro¨ der, Peter Schro¨ der, Wolfgang vie Sement, Daniel Senk, Isabelle Sesoren, Jean- gang Herzog, Hans Hess, Carsten Hebeling, Martin Schro¨ ter, Doris Schulte, Klaus Schulten, Dietmar Schultz, Francois Seveyrac, Olivier Simorre, Pierre-Francois Hestermann, Markus Heyenbrock, Silke Hietkamp, Pe- Andreas Schumacher, Joachim Schuster, Manfred Sinoir, Gerard Slama, Gilles Sorbe, Francis Soret, San- ter Hildebrand, Manfred Hilgedieck, Matthias Hof- Schu¨ tz, Heinrich Schwadorf, Toralf Schwarz, Hans- drine Soria-Berdugo, Philippe Soskin, Jean-Claude Sou- mann, Hartmut Hohensee, Evelyn Hohnstein, Her- Go¨ tz Schweigho¨ fer, Lorenz Schweyer, Bernd Sczesni, lary, Patrick Spiess, Francois Spilthooren, Marc Stein- bert Huch, Gerhard Humke, Rudolph Hu¨ ndgen, Per Segebrecht, Bringfried Seidel, Karin Seifert, Hans- berger, Jean-Jacques Stoll, Alain Stoll, Patrick Strentz, Hendrik Hu¨ ning, Rolf Huntemann, Wolfgang Hup- Peter Seifert, Anne-Monika Seiler, Christoph Seitz, Ingo Noel Tallet, Denis Taminau, Sunhok Tan, Michel Tap, pertz, Thomas Hu¨ tt, Horst Huttner, Werner Ihle, Stefan Senftleber, Jo¨ rg Simon, Almut Sindl, Lutz Sinn, Ulrich Philippe Tarouel, Patrick Taverne, Elisabeth Templier- Jacobi, Johannes Ja¨ ger, Bernd-Ulrich Ja¨ ger, Norbert H. Sinning, Ulrich Sliwka, Thomas Sommerlatte, Ti- Gauthier, Michel Terrail, Jean-Pierre Terrien, Jean Jahnke, Andreas Jankowski, Sybille Ja¨ nsch, Dirk Jesing- rapol Sorncharoen, Wolfgang Sperle, Alfred Spitzer, Theoule, Pascal Tiberghien, Kiet Phong Tiev, Remy Tis- haus, Judith Jeske, Martin Jung, Gerhard Jungblut, Ul- Detlef Sta¨ dt, Jens Stadtmu¨ ller, Angela Stahl, Andreas serand, Judah Toledano, Bernard Tomaszenwski, rich Junge, Wolfgang G. Jungmann, Jost Kaiser, Wol- Stegner, Wolfgang Stein, Jo¨ rg Stein, Jo¨ rg Steindorf, Corinne Toto-Grisoni, Pierre Touzet, Eric Tricoire, Fran- fram Kaiser, Martin Kajzar, Tunca Karakas, Erdogan Michael Steinle, Andrea Steinmeier, Gunter Stenzel, cois Tricot, Pierre Triot, Thierry Valette, Elodie Van- Karatay, Sabine Karl, Karim Kaviani-Nejad, Nader Klaus Stiegler, Bettina Sto¨ cking, Hans-Georg Stohrer, dooren, Christine Vanhoutte, Stephane Vanier, Fre- Kayali, Thomas Keienburg, Horst Keller, Guido Ralf Hans-Ju¨ rgen Stroh, Gerson Strubel, Janusz Swist- deric Vayre, Jose Vedrenne, Paul Venjus, Gabriel Kebler, Andreas Kirsch, Christiane Klein, Michael Klein, owski, Angelika Ta¨ gder, Jens Taggeselle, Gunnar Venturini, Erick Verlet, Gilles Verney, Jean-Francois Axel Kleinert, Arthur Klementz, Johann-Wilhelm Taubert, Sven Tauchert, Maria-Elisabeth Thamm, Ger- Vernhes, Michel Verquerre, Jean-Christophe Vialette, Klo¨ pper, Eva Kmoth, Olaf Knispel, Erich Knobloch, hard Thiel, Manuela Thinesse-Mallwitz, Joachim Thum, Rodrigue Vienne, Philippe Vigier, Jean-Luc Vignoulle, Volker Koch, Stephan Kochen, Wilfried Kochha¨ user, Martin Tietz, Karin Todoroff, Evelyne Traub-Bobrich, Laetitia Villon, Christian Vincey, Jean Yves Vogel, Pa- Andreas Koeppel, Steffen Christian Kohl, Andreas Steffen Tro¨ ger, Ulrich Tuchscherer, Bruno Tulaj, An- trick Vogt, Jean Vonarx, Manh-Hung Vuong, Jean- Ko¨ hler, Christian Ko¨ hler, Klaus Kohlhas, Ralph D. Ko¨ hn, dreas Turowski, Stefan Tymiec, Evelyne Udvari, Ger- Luc Weigel, Christian Wencker, Nathalie Wey, Phil- Kai Ko¨ nemann, Ariana Konschak, Annette Konstan- trud Ullerich, Christine Unger, Ingeborg Utz, Peter van ippe Winter, Veronique Wodey, Jean-Louis Wurtz, zer, Ute Kopplin, Tillmann Kornadt, Robert Kortas, Hasselt, Robert Villis, Achim Vogt, Cornelia Vo¨ lckers, Frank Yoh, Stephane Yvenov, Antoine Zaknoune, Gilles Thomas Kossow, Katja Kraaz, Alfred Kra¨ mer, Gudun Jan Vo¨ lker, Thomas Vo¨ ller, Peter Baron von Bilder- Zamaria, Fernand Zerbib, Patrice Zoro. Krause, Peter Kreckel, Klaus Kretschmer, Stephan ling, Stephan von Molitor, Andreas Voskamp, An- Germany: Patrick Abdul-Malak, Christoph Abel, Mi- Kretschmer, Wolf Kretzschmar, Christian Krupp, Re- nette Wagner, Bernd Wagner, Friedrich Walther, Csila- chael Achatz, Sahika Akalin, Christian Alexander, Hen- inhard Kuhn, Richard Kuhnen, Heike Kunert, Steffi Maria Weider, Bernd Weier, Jens Weilacher, Cornelia drik Altenka¨ mper, Manuela Andres, Christoph Ang- Kunze, Doris Ku¨ ther, Cornelia Kutscherskij, Beata Kutz, Weirich, Rainer Weislogel, Go¨ tz Weissinger, Mat- envoort, Matthias Appy, Cord Arkenau, Martin Bach, Susanna Labitzke, Hans-Joseph Lang, Thomas Lange, thias Wenck, Ju¨ rgen Werner, Manfred Werner, Georg Stefan Baier, Claus Ballstaedt, Constantin Baran, Marius Laurentius Lanta, Christoph Lanzendo¨ rfer, John E. La- Weyers, Kurt Wiedemann, Marie-Luise Wiedemann, Barbuia, Christian Barho, Alexandra Bassen auf dem sana, Suso Lederle, Kurt Lempke, Martin Lenfers, Ute Susanne Wiegank, Eckhard Wilbrandt, Wolfgang Brinke, Oskar Bauer, Martin Bauersachs, Clemens Lenk, Matthias Leyer, Ina Lipp, Regina Lippert, Ber- Wildenauer, Birgit Willers, Wolf-Ru¨ diger Winter, Di- Bauknecht, Isabel Baumann, Christian Beck, Rudolf thold Litzinger, Bruno Lo¨ prich, Konrad Lo¨ ssl, Sabine eter Wirtz, Hermann F. Wissmu¨ ller, Claus-Henning Becker, Hans-Joachim Becker, Helmut Beermann, Die- Ludewig, Guido Ludwig, Stefan Lukannek, Martin Wolde, Mandy Woschech, Martin Wunderlich, ter Bemmann, Sibylle Berdermann, Olaf Besser, Ron- Ma¨ gdefrau, Roman Mantaj, Martin Markreiter, Fares Volker Zeese, Volker Zens, Klaus Zimmermann, Ado ald Beyer, Rainer Birke, Michael Bodammer, Ralf Martak, Toralf Marten, Angela May, Herbert Mayer, Zorn.

Greece: Georgia Asimi, Christos Bakalis, Charalam- Carlos Eduardo Heredia Rivera, David Hernandez, Jorge Matsuyama, Hajime Memezawa, Shinsuke Mii, Kuni- bos Bakopoulos, Dimitrios Balis, Konstantinos Baltatzis, Hernandez, Julia Lucy Madrid Alvaro, Felix Medina, hiko Mitsuo, Hironobu Miyai, Yosuke Miyakawa, Su- Athanasios Basdekidis, Ioannis Caraindros, Agni Jose Alberto Minchola Haro, Miguel Mini, Guido sumu Miyamoto, Kazuo Miyatani, Yoshihiro Miyazaki, Chatsiou, Periklis Chatzigiannis, George Dakos, Geor- Molina, Javier Moya, Miguel Esteban Ortiz, Alex- Yukihito Miyazawa, Hiroshi Mochizuki, Shin-Ichi gia Dantsi, George Deligianinis, Athanasios Demiris, ander Parajeles, Clemente Alberto Ramos, Edgar Momomura, Yutaka Mori, Hisao Mori, Noriyasu Mori, Ioannis Dermitzakis, Chrisoula Dima, Christos Rodriguez, Gustavo Luis Saravia Risso, Jose Mario Keisuke Morimoto, Ichiro Morita, Hiroshi Moriyama, Dimitriadis, Michael Fatsis, George Floros, Apostolos Sprok, Diego Ricardo Tapia Villagomez, Jaime Tortos- Katsuhiko Motokawa, Tomoyuki Mukai, Makoto Garbis, Ilias Georgiadis, Nikolaos Georgogiannis, The- Guzman, Victor Urrutia, Dario Veras Sanchez, Jean Paul Murahashi, Satoshi Murao, Tsutomu Nagamitsu, Take- odoros Groutsis, Lazaros Kapetanakis, Nikolaos Vercauteren Dupont, Pablo Villa-Garcia Martinez, Mary hiko Nagao, Kazuya Nagata, Yasuhiko Nakada, To- Kapsoudas, Sofia Karabali, Dimitrios Karagiannis, Vinocour. moko Nakagami, Joji Nakagawara, Kenichi Nakahara, Sylvia Karalioliou, Aggelos Klitsas, Nikolaos Kotsis, Israel: Aviva Abramovitz, Sharona Amar, Ram Taku Nakajima, Yasuhiro Nakamura, Toru Nakamura, Paris Koulouzakis, Stilianos Ktistakis, Simeon Avrahami, Aya Biderman, Nataly Davidov, Dana Faibel, Yoshiki Nakamura, Yukio Nakamura, Takashi Liberakis, Efthimia Mandalaki, Alekos Manolakos, Al- Oro-Nory Flechner, Frida Glikberg, Marion Hefer, Nakamura, Masio Nakamura, Masaichi Nakamura, Hi- exandra Maranga, Nikolaos Markoglou, Nikolaos Yaakov Henkin, Edith Klain, Roza Kleiman, Batya roshi Nakane, Tatsuaki Nakato, Masao Nakatsuka, Seii- Meramvoliotakis, Christos Milopoulos, Nikolaos Kornboim, Tatiana Lev, Pircha Levie, Abu-Katash chi Nakayama, Tsuyoshi Nakazato, Kishio Nanjo, Mimilas, Ioannis Moschonas, Ioannis Navrouzoglou, Mahmoud, Ayelet Mendelson, Lea Mor, Zvi Chalom Manabu Narimiya, Teruhiko Negishi, Toyoharu Panagiotis Panagiotopoulos, Dimitrios Papaeconomou, Moran, Gila Nitay, Irine Ostrovski, Yaakov Pshetizkj, Nemoto, Mitsuro Niinomi, Kazuhiko Nishigaki, Hideo Nikolaos Papathanasiou, Irini Pappa, Dimitrios Parissis, Ayala Reinitz, Hanna Reiss, Raisa Rivkind, Larisa Roch- Nishikawa, Hideo Nishimura, Masao Nitta, Masahiro Charalambos Petras, Ilias Petropoulos, Nikolaos Klipper, Dorith Rosner-Kamana, Tilda Sabah, Maya Nitta, Koichi Noda, Hiroshi Noda, Koji Noma, Hachiro Pontikakis, Charalambos Pontikis, Georgios Ragias, Spi- Schuldman, Eran Segal, Irena Shtraikher, Bernadiner Obata, Yoshiki Ochi, Toya Ochi, Yuji Ogawa, Takuo ros Rigas, Panagiota Riza, Panagiotis Sabatakakis, Vi- Sophia, Ilan Strausberg, Michael Umansky, Selma Ogawa, Akira Ogawa, Atsushi Ogo, Shinya Ohagi, ron Sitis, Andreas Skanavis, Fotini Skirla, Michalis Wainsztok, Eli Wertmann, Dorota Wrobel-Zaher, Yoshifumi Oishi, Kaiyo Oiwa, Masataka Ojiro, Kazu- Sotiriou, Michael Stakiadis, Sonia Stilianoudaki, Anna Cherna Zeltcer, Constantin Zhuravlove, Grigory nori Okada, Kenji Okada, Motoi Okada, Yasushi Syrigou, Ioannis Tachmatzidis, Konstantinos Takis, Zibuleusky. Okada, Masaya Okamoto, Yukiharu Okamoto, Shinya Pagona Tassopoulou, Konstantinos Tekos, Antonis Japan: Koji Abe, Nobuyuki Abe, Masayoshi Adachi, Okamoto, Masamichi Okubo, Satoshi Okuda, Theodorakis, Ilias Theodoropoulos, Theofrastos Tsakiris, Hisashi Adachi, Hideaki Akiyama, Yoshichika Anami, Tomoyuki Onishi, Naomi Ono, Tatsuyuki Onodera, Maria Tserkezou, Ioannis Varnavas, Pavlidou Venetia, Masahiko Aosaki, Teruhiko Aoyagi, Rika Araki, At- Toshihiro Onohara, Koji Osumi, Takashi Ota, Nikolaos Vrachnakis, George Ziros, Ioannis Zouberis. suko Ashiba, Keita Atou, Kojiro Awano, Nobuyoshi Masakatsu Otani, Nozomu Otani, Haruo Ozaki, Hideki Hong Kong: Chi Keung Au Yeong, Norman Chan, Kin Azuma, Akihiro Azuma, Hideaki Bujo, Keiji Chida, Ha- Ozawa, Hiroshige Sairenji, Kenichi Sakai, Kikuo Sakai, Choi, Shu Lap Chow, Chor Lup Chu, Hau Kwong ruhiko Date, Toshiyuki Degawa, Kenichi Doniwa, Kenji Susumu Sakamoto, Ryuichi Sano, Akira Sato, Hiroshi Chung, Victor Goh, Yim Fai Kong, Chi Sing Ku, Al- Ebihara, Genshi Egusa, Yutaka Eki, Masamitsu Endo, Sato, Jo Sato, Koichi Sato, Ryoji Sato, Shoji Sato, Norio exander C. K. Lam, Yuk Tong Lau, Chi Wing Lo, Wing Tsuyoshi Enomoto, Takashi Fujii, Hitoshi Fujimori, Sawamura, Kazuhiko Segawa, Takao Seki, Teisaburo Fai Ng, Peter Tong, Wing Kwong Tong, Chun Au Yoshihisa Fujimoto, Kazuteru Fujimoto, Harutoshi Sekiya, Takayoshi Senda, Yoichi Shibasaki, Mikio Shida, Tsang, Hing Sing Tsui, Bun-Lap Wong, Wing Kwong Fujimura, Nobuaki Fujio, Motohiro Fujita, Toshiyuki Toshiki Shigeyama, Norihiko Shiiya, Ichiro Shimada, Wong, Yu Kai Yu. Fujiwara, Atsushi Fukuda, Yoshiharu Fukuda, Ryuzo Shoji Shindo, Kiyohito Shinno, Isanori Shinohara, Hungary: Agnes Adam, Gabor Antalics, Vilma Balas, Fukunaga, Takatoshi Furuya, Shigeru Fuse, Takahisa Uichiro Shintani, Teruo Shiraki, Kazutaka Siomi, Ma- Erika Bartfai, Zsolt Bartha, Monika Bata, Bela Bernath, Fuse, Jun Goto, Katsumasa Goto, Rikuzo Hamada, koto Sonobe, Katsunori Sugisaki, Hiroaki Sugiura, Imre Bodnar, Imre Csomos, Melinda Csordas, Eva Tomio Hamada, Shin Hamamoto, Tadashi Hanabusa, Naoyuki Suto, Tomoya Suwa, Kazuhiko Suyama, Shin Czucza, Laszlo Darvai, Ilona Dulai, Gyorgy Eberling, Toshiaki Hanafusa, Nobuo Handa, Kazuhiro Hara, Suzuki, Masahiro Suzuki, Seiji Suzuki, Michiyasu Suzuki, Veronika Endre, Katalin Farkas, Gyongy Foldesi, San- Yoshiaki Harada, Seiichi Haruta, Toshikazu Hashizume, Akifumi Suzuki, Masao Suzuki, Atsushi Tabuchi, Ma- dor Forgacs, Boldizsar Garai, Gyorgy Gergely, Istvan Akira Hattori, Masamichi Hayashi, Yasuo Hayashi, Ka- sami Tada, Naoko Tadokoro, Shuichi Taguchi, Soichi Gubucz, Ildiko Hajdara, Jozsef Hamvas, Peter Harcos, zuyuki Hida, Kiichiro Higahi, Susumu Higaki, Yoshi- Taguchi, Yuji Tajiri, Tetsuya Takahashi, Toshihiro Agnes Hasitz, Gyula Hegedus, Marianna Hegyi, Zsuzsa hisa Higashi, Masafumi Higashidate, Tetsuya Hira- Takata, Yasuo Takeda, Manabu Takei, Naoki Takeichi, Hermann, Katalin Jakab, Istvan Juhasz, Krisztian Juhasz, moto, Koji Hirano, Kenichi Hirata, Katsuhiko Hiratani, Hidehiro Takekawa, Yasunori Takemoto, Takashi Gal Katalin, Andor Keresztes, Istvan Kosa, Agnes Koves, Osamu Hirono, Atsushi Hirotani, Ichiro Hisatome, Takenaka, Toshiharu Takeuchi, Noriyuki Takeyasu, Mo- Jozsef Lakatos, Laszlo Lippai, Tibor Lovasz, Geza Hideki Hondo, Jin Hoshino, Tsutomu Hosoi, Naohisa tohiro Takita, Shunya Takizawa, Norio Tanahashi, Kimi- Lupkovics, Anna Magyar, Eszter Magyarosy, Tamas Hosomi, Setsuro Ibayashi, Toshio Igaki, Tatsuyuki Iijima, taka Tanaka, Katsuhiro Tanaka, Satoshi Taniguchi, Major, Attila Makai, Rozalia Marton, Katalin Mede, Kiichiro Iikuni, Hiroshi Ikenouchi, Katsuji Imai, Kenji Toshihiro Tanzawa, Kazuhiro Tashima, Hirokazu Edit Metz, Marta Molnar, Aniko Muranyi, Zoltan Nagy, Imai, Takeo Imai, Shigehiro Imamura, Tetsuya Inatsu, Tashiro, Yoshihisa Tatsuoka, Koji Tenda, Tamio Maria Olasz, Katalin Paulo, Ildiko Penner, Zsuzsanna Isao Inoue, Ikuo Inoue, Shun Ishibashi, Toshiyuki Teramoto, Muneshige Tobita, Ryohei Todo, Ryuji Revesz, Pal Roth, Szilveszter Rozsa, Csilla Sarkadi, Ju- Ishibashi, Kazufumi Ishida, Shiro Ishida, Naoki Ishige, Tominaga, Makoto Tominaga, Atsufumi Tomohiro, Hi- dit Semjen, Tas Attila Sipos, Eva Sitkei, Gusztav Strebely, Masayuki Ishihara, Hisamitsu Ishihara, Yoshiyuki Ishii, rotaka Toshimori, Toshio Tsubokura, Takuya Zsolt Sudar, Zoltan Szabo, Szabolcs Szepesvari, Geza Yasuaki Ishimaru, Hiroshige Itakura, Tatsuro Ito, Tat- Tsuchihashi, Tetsuya Tsukahara, Kengo Tsukahara, Hi- Toth, Gabor Trapp, Arpad Zsigmond, Zoltan Zuberecz. suya Ito, Norio Iwaki, Masahiro Iwamoto, Tetsu Iwao, roshi Tsutsui, Naomichi Uchida, Hirokazu Ueda, Indonesia: John Adam, Achdiat Agoes, Ira Takashi Iwase, Yuichi Izumi, Yosuke Jinnouchi, Hideto Daisuke Uematsu, Hiroshi Uenohara, Makoto Ujihara, Andaningsih-Rahardja, Robert Arjuna, Ahmad As- Joki, Noboru Kagawa, Hiroshi Kaieda, Takashi Takuya Umemoto, Masaaki Uno, Masaharu Urakaze, die, Achmad Basyah, I. Gusti Ngurah Ketut Budiarsa, Kajikawa, Tatsushi Kamiya, Haruo Kamiya, Kotaro Yoshifumi Wada, Yukio Wakuta, Kazunori Wasada, Djokorijanto Dirdjaningrat, Robertus Djoko- Kaneko, Yoshifumi Kanemaru, Atsunori Kashiwagi, Hi- Kiyoshi Watanabe, Tsuyoshi Watanabe, Takao Watarai, moeljanto, Mochammad Fathoni, Billy Indra Gu- toshi Kato, Kenichi Kato, Hiroshi Katsume, Toshihiro Toshikazu Yabe, Zenju Yamada, Kenichi Yamada, At- nawan, Margono Achyar Hendromartono, Laksmi As- Kawabata, Tadashi Kawaguchi, Kazuya Kawahara, suo Yamada, Takeshi Yamada, Tetsuhiro Yamada, anti Kadarjono, Harmani Kalim, Isfanuddin Nyak Kaoy, Toshiharu Kawamoto, Yasuo Kida, Mikihiro Kihara, Hajime Yamagata, Tatsuyuki Yamaguchi, Kazuhiko Sjukri Karim, Sutomo Kasiman, Dede Kusmana, Charles Takashi Kimura, Hironori Kimura, Atsushi Kinoshita, Yamaguchi, Kazuo Yamaguchi, Shuhei Yamaguchi, Limantoro, Robertus Arifin Limoa, Augusta Lukman Tetsuya Kitagawa, Kazuo Kitagawa, Kazuyuki Masahiro Yamamoto, Yasumasa Yamamoto, Hiroshi Arifin, Lukman Hakim Makmun Mardianto, Djoko Kitamura, Hirokazu Kitamura, Tomoki Kitano, Hi- Yamanari, Kanji Yamane, Midori Yamano, Masahiro Maryono, Irmalita Mazwar, Jusuf Misbach, Paskalis roaki Kitaoka, Kyoko Kobayashi, Yasutaka Kobaya- Yamasaki, Kenji Yamasaki, Katsuhiro Yamashita, Ma- Nangoi, Handoyo Pudjowidyanto, Hari Purnomo, I. shi, Hisashi Kobayashi, Yoshio Kobayashi, Masayoshi safumi Yamashita, Iwao Yamashita, Kazumasa Gusti Ngurah Putra Gunadhi, Dani Rahmawati, Sodiqur Kobayasi, Nobuo Kohara, Junko Koide, Junji Koizumi, Yamatani, Yoshimitsu Yamazaki, Kaoru Yanagihara, Rifqi, Kiking Ritarwan, Anwar Santoso, Teguh Hiroshi Komachi, Hidehiko Konno, Yukihiro Koretsune, Takumi Yasugi, Shozo Yasuoka, Hidehiro Yokochi, Santoso, Suratno Sastrosukarno, Siti Setiati, Suroto Tatsuo Koriyama, Seiichiro Koseki, Satoshi Kotorii, Ka- Norihiko Yokomori, Hiromitsu Yokota, Hitoshi Yokota, Setijorumekso, Yanuar Soehartono, Djadjang Suhana, zunori Koyama, Michiya Kubo, Masazumi Kume, Ma- Naoto Yokota, Noboru Yokota, Toru Yokotani, Hi- Josef A. Hendro Susilo, I. Nengah Dwi Sutanegara, Au- sanari Kunimoto, Makoto Kunisaki, Ryuji Kunitomo, royuki Yokoyama, Shigeru Yokoyama, Kazuya lia Syawal, Sutikno Tanuwidjaja, Trisulo Wasyanto, I. Yukio Kuniyoshi, Keiichi Kuroki, Masafumi Kuzuya, Ma- Yonezawa, Yoshihiro Yonezawa, Minako Yoshida, Ma- Wayan Wita, Hans Cahyadi Yeo. sahiro Makino, Yasuhiro Manabe, Katsuya Maruyama, saki Yoshikawa, Koichi Yoshimura, Rikiya Yoshimura, Interlatina: Ana Cecilia Arango, Jorge Arauz Chavar- Taro Maruyama, Motoko Masaki, Ryoichi Masuda, Kimihiko Yoshimura, Shinichi Yoshimura, Kenichi ria, Aron Benzadon Cohen, Jose Cabrera, Boris Cas- Masahisa Masuda, Susumu Matsubara, Junichi Yoshioka, Narihito Yoshioka, Toshihiro Yududo. tillo, Edith Haydee Chavez Huepella, Chih Hao Cheng Matsubara, Masanobu Matsuda, Makoto Kingdom of Saudi Arabia: Hussein Algahtani, Ashraf Ku, Ernesto Diaz Alvarez, Rosa Eliana Dina Jimenez, Matsumura, Takeshi Matsuo, Tatsuru Matsuoka, Hammouda, Waleed Khoja, Mostafa Abdel Ghany, Hernan Espinosa, Sandra Natacha Espinoza Ceden˜o, Teruhiko Matsushima, Yoshifusa Matsuura, Hiroyuki Abdul Aziz Al Zamzami, Mohammed Ali Ali, Mostafa

Ali Ahmed Alshamiri, Saeed Bohlega, Fayez El Shaer, van de Pavoordt, Rob van der Heijden, Laura van Dort- Popescu, Dinu Cristian Popescu, Maria-Rodica Pro- Yousif Elmaleeh, Ibrahim Wasfy Gamal, Abdulhalim mont, Jan van Iersel, Hero van Urk, Wim Verhagen, dan, Tudor Protopopescu, Mariana Radoi, Maria Ro- Kinsara, Mohammad Kurdi, Ahmed Mabrouk, Asif Ma- Adrie Withagen. taru, Mihaela Rugina, Horatiu Rus, Anca Paraschiva lik, Hassan Raslan, Ashraf Shaaban, Hesham Taha, Rad- Philippines: Elizabeth Aguilar, Maria Ellen Grace Rusu, Radu Andy Sascau, Marinela Serban, Adela Ser- wan Zaidan. Alferos, Maria Grace Ang, Veeda Michelle Anlacan, ban, Costel-Sorin Stamate, Delia Maria Stanca, Liana Korea: Tae-Hoon Ahn, Sei Hyun Baik, In-Ho Chae, Ki Maria Antonette Lourdes Aportadera, Abdias Aquino, Stanescu, Cristian Statescu, Felicia Stefanache, Cris- Hyun Cho, Woong Hwan Choi, Yong Kil Choi, Kyung- Celine Aquino, Joel Ernest Araniego, Alberto Atilano, tina Mihaela Tanaseanu, Marina Ticmeanu, Diana Tint, Cheon Chung, Ji Hoe Heo, Yangsoo Jang, Myung Ho Fe Bacsal, Yul Balleza, Benny Barbas, Roy Joseph Bar- Cristina Tirziu, Cristina Tiu, Ildiko Toldisan, Luminita Jeong, Dae Soo Jung, Heung-Sun Kang, Sun Woo Kim, cinas, Noel Belonguel, Jenny Beltran, Deborah Ber- Toma, Nicoleta Andreea Tovirnac, Simona Octavi- Jong Sung Kim, Kyung-Soo Kim, Sung Koo Kim, Yong nardo, Florenz Eubil Bilocura, Ester Bitanga, Amelita ana Treidler, Luminita Tudor, Valerica Tudorica, Daniela Ki Kim, Kee-Sik Kim, Dae Hie Lee, Kwang Ho Lee, Brillantes, Leonor Cabral-Lim, Emerito Calderon, Turdeanu, Sorin Tuta, Vitalie Vacaras, Ioana Varga, Kwang-Soo Lee, Byung-Chul Lee, Inkyu Lee, Kyong Warner Camarao, Maria Lourdes Canto, Raymond Jude Marin Vasile, Radu-Gabriel Vatasescu, Crisanda Vil- Soo Park, Jeong Euy Park, Seong-Wook Park, Sung Changco, Carlos Chua, Marietta Crisostomo, Joven ciu, Dragos Vinereanu, Marius Marcian Vintila, Gab- Woo Park, Chong-Yun Rhim, Ki-Bae Seung, Ho- Cuanang, Edna Cuasay, Rex Decolongon, Manuel Del riela Vulpe, Cornelia Zaharia, Simona Zaharia, Lucian Young Son, Jeong-Taek Woo, Sang-Doe Yi, Byung- Moro, Erwin Del Rosario, Eduardo de los Reyes, Ale- Zarma. Woo Yoon. jandro Diaz, Carissa Paz Dioquino, Jane Doctora, Mar- Russian Federation: Fail Ageev, Dariga Akasheva, Lebanon: Hassan Abdallah, Joe Abi Raad, Grace Abi celito Durante, Delfin Encarnacion, Roy Entienza, Ce- Gregory Aroutiounov, Boris Bart, Boris Bondarenko, Rizk, Michel Abu Salbi, Khalil Ashkar, Farida Atallah, sar Estalilla, Renato Evangelista, Erman Fandialan, Vladimir Chernyavski, Irina Demidova, Oxana Drap- Pierre Awwad, Elie Chammas, Mostafa El Nakib, Ka- Carmelita Fernandez, Roy Ferrer, Francisco Fuentes, kina, Natalia Egorova, Anatoly Evdokimov, Igor Fo- mel Ezzeddine, Adel Ghaddar, Beatrice Khater, Sa- Marie Simonette Ganzon, Florimond Garcia, Ruby Go, min, Marina Freydlina, Albert Galyavich, Maria Glezer, lem Maaliki, Malek Makarem, Michel Matar, Hanna Manolete Guerrero, Lerrie Gutierrez, Alina Fatima Ho- Nikolai Gratsiansky, Yury Grinstein, Nikolai Horev, Alla Mattar, Riachi Mounir, Umayya Musharrafieh, Clau- jilla, Ranulfo Javelosa, Sjoberg Kho, Rogelio Libar- Ivleva, Michael Karpenko, Yuri Karpov, Ludmila Katel- dine Nasr, Naji Riachi, Mounzer Saleh, Elie Stephan, nes, Marcelo Lim, Aileen Cynthia Llarena, Johnny Lokin, nitskaya, Perch Kazantchian, Roman Khokhlov, Oleg Georges Tabet. Marilou Maglana, Francisco Maleza, Elma Maranon, Khrustalev, Andrew Kiritchenko, Zhanna Kobalava, Lithuania: Nijole Bodindorfiene, Vytautas Docka, Laima Maria Conception Marcelo, Apistar Matias, Clarissa Irina Kolina, Andrey Komarov, Lioudmila Korenko, Jankauskiene, Jurate Kojeliene, Milda Kovaite, Za- Mendoza, Rommel Montes, Jose Navarro, Reynaldo Valery Koshkin, Sergey Kotov, Natalya Koziolova, Eka- neta Petrulioniene, Ignas Tamosuitis, Birute Terbe- Neri, Orlino Pacioles, Patricio Palmes, Joel Paz, Rene terina Kropacheva, Valery Kukharchuk, Pavel La- tiene, Danute Zaronskiene. Punsalan, Felix Eduardo Punzalan, Francis Marie Pu- guta, Petr Lebedev, Alexander Lipchenko, Veronika Malaysia: Raiha Abdul Kahar Abd Ghapar, Nah Ab- rino, Maria Lina Renales, Eugenio Reyes, Clara Rivera, Lopukhova, Valentin Markov, Anatoly Martunov, Irina dul Khalid, Hjh Aziah Ahmad Mahayiddin, Tun Fizi Am- Godfrey Robeniol, Raymond Rosales, Reynaldo Ro- Mironova, Vladimir Naumov, David Nebieridze, Igor brose, Choon Kiat Ang, Zainal Ariffin Azizi, Raymond sales, Romulo Rommel Rosita, Diana Jean Roxas, Ar- Novitsky, Iana Orlova, Nikolay Pavlov, Anatoly Pok- Azman Ali, Hamidon Basri, Wei Ling Chan, Siew Pheng temio Roxas, Elson Sedilla, Johnny Shia, Edgar Tan, rovsky, Victor Rapovka, Oleg Rodnenkov, Ana- Chan, Sau Kong Chang, Kok Han Chee, Yook Chin Aurora Tanzo, Dennis James Torres, Ramoncito Tria, stassiya Sankova, Sergei Shalaev, Igor Shaposhnik, Ma- Chia, Yoon Sin Chong, Choon Hooi Choong, Santhi Wilson Tulmo, Tommy Ty Willing, Luciene Lourdes rina Shestakova, Vladimir Shmirev, Alexander Shpektor, Datuk Puvanarajah, Yin Khet Fung, Eng Leong Goh, Villacin. Vladimir Shulman, Boris Sidorenko, Alexey Sizov, An- Hanif Hussein, Omar Ismail, Zulkeflee Ismail, Shaiful Portugal: Luis Bimbo, Rui Duarte, Augusto Ferreira, drey Skvortsov, Veronika Skvortsova, Ivan Sokolov, Bahari Ismail, Naimaton Ismail, Nor Azmi Kamarud- Jorge Ferreira, Correia Junior, Filipe Macedo, Rui Me- Michail Statsenko, Gennady Storozhakov, Leonid din, Norshinah Kamarudin, Balachandran Kan- don, Joao Morais, Duarte Noronha, Jose Osorio, Car- Stratchounski, Tatyana Sukhinina, Vitaly Sulimov, Nina dasamy, Soon Khai Lee, Yew Pung Leong, Houng Bang los Perdigao, Paulo Pessanha De Andrade, Jorge Puig, Sysoeva, Marine Tanashyan, Konstantine Tebloev, Vic- Liew, Chee Khoon Liew, Phanindranath Mahadasa, Elisabete Rodrigues, Jose Sampaio, Manuel Viana tor Tutunov, Alexander Upnitsky, Natalya Yarokhno, Choon Soon Mak, Julia Shahnaz Merican, Masni Mo- Costa, Edgar Wellenkamp. Ludmila Yeliseyeva, Vladimir Zadionchenko, Alara Za- hamad, Chirk Jenn Ng, Hasral Noor Hasni, Tiong Kiam Romania: Valeria Carmen Albu, Daniela Cristina An- kirova, Yekaterina Zharova. Ong, David Kwang Leng Quek, Vijayasingam Rajas- ghel, Florina-Anca Antochi, Eduard Apetrei, Marina Singapore: Poh Kit Ang, Sivathasan Cumaraswamy, ingam, Kui Hian Sim, Ramesh Singh Veriah, Jeyain- Catalina Arsenescu, Valeria Gloria Badiu, Ovidiu Al- Bernard Chan, Nang Fong Chan, Hui Meng Chang, dran Sinnadurai, Kay Sin Tan, Lian Kim Tee, Soon Wee exandru Bajenaru, Rodica Ioana Balasa, Viorica Ban- Christopher Li Hsian Chen, Thomas Cherian, Kok Tiang, Wan Bebakar Wan Mohamad, Zurkarnai Yu- gau, Constanta Banica, Carmen Barbulescu, Gabriela Hoong Chia, Piang Ngok Chong, Sui Meng Chua, Pong suf. Bicescu, Elena Bobescu, Gabriel Boeru, Ruxandra Kuan Chua, Mark L. A. Da Costa, Deidra Anne De Silva, Mexico: Arturo Abundes Velasco, Geronimo Aguayo, Stefana Bogdan, Valentin Bohotin, Adrian Constan- Binayak Deb, Mukund Doshi, Peter Eng, Robert Gan, Marco Antonio Alcocer Gamba, Graciela Alexander- tin Bucsa, Mihaela Bustan, Adrian Catalin Buzea, Ana- Khee Hock Goh, King Hee Ho, Gunasegaran Kuru- son, Melchor Alpizar, Luis Enrique Amaya, Antonio Varvara Campeanu, Radu Capalneanu, Andrei Carp, gulasigamoney, Peng Chin Kek, Philip Siam Soon Koh, Arauz, Armando Astorga, Jose Ramon Azpiri, Fer- Ovidiu Chioncel, Cristian Chiriac, Ruxanda-Dana Adrian Thong Kiang Koh, Seng Long Koo, Chee nando Barinagarrementeria, Enrique Bernal Esbrada, Chirileanu, Mircea Cinteza, Aurora Constantinescu, Choong Koo, Chon Sham Lee, Tang Yin Lee, Stanley Hector Manuel Briseno Ramirez, Cesar Calvo, Carlos Elena Constantinescu, Elvira Craiu, Carmen Cristea, Liew, Ah Kiong Liew, Ing Haan Lim, Michael Lim, Chin Cauto, Hector Colorado, Jorge Cortes, Jorge Cossio, Roxana Cruce, Dan Iulian Cuciureanu, Ioana Cristina Hock Lim, Su Chi Lim, Jayaram Lingamanaicker, Lip Manuel Odin De Los Rios Ibarra, Rodrigo De Zata- Daha, Anca Dan, Gheorghe-Andrei Dan, Roxana- Ping Low, Suresh Mahtani, Koon Hou Mak, Sebas- rain, Carlos Diaz, Luis Eng, Jesus Esparragoza, Luis Espi- Oana Darabont, Dan Deleanu, Doina Ruxandra tian Mathew, Richard Mong Hoo Ng, Ramani Na- nosa Sierra, Carlos Espinoza, Pedro Fernandez Bon- Dimulescu, Cristian Dina, Mihail Dinesch, Maria Doro- rayanaswamy Venketasubramanian, Peter Teck Hwee etti, Elias Garcia Cantu, Rodrigo Garcia Martinez, bantu, Andreea Dragulescu, Stefan Iosif Dragulescu, Ng, Sarani Omar, Jason Pang, Raymond Chee Seong Alejandro Garza Guerra, Felipe De Jesus Gonzalez Bogdan Dumitriu, Amalia Ene, Cristian Falup- Seet, Vijay Sharma, Kim Bin Siah, Charles Siow, Lui Camid, Francisco Guerrero Pasqueira, Ismael Her- Pecurariu, Teodor Stefan Fischer, Angela Mirela Gave- Cheng Sng, Huay Cheem Tan, Ru San Tan, Melvin Tan, nandez, Andrei Kostine, Jose Luis Leiva, Leonardo Lla- nea, Susana Geleriu, George Georgescu, Ioan Teodor John Choon Heng Tan, Yong Teck Tan, Vincent Tan, mas-Lopez, Berenice Lopez, Julio Lopez Cuellar, Mauri- Gheorghe, Leonida Gherasim, Ioana-Adriana Jam Chin Tay, Hock Luen Teoh, Hoo Ing Tong, Thean cio Lopez Meneses, Antonio Marcos, Sergio Najar Ghiorghiu, Carmen Ginghina, Alina Giuca, Ioan Laur- Seng Tong, Jane Tran, Albert Wee, Teck Wee Wong, Lopez, Jacobo Nettel, Fernando Ortiz Galvan, Rog- entiu Gutiu, Anca Hancu, Diana Nicoleta Hodorog, Meng Cheong Wong. elio Peralta, Juan Carlos Perez Garcia, Alejandra Ranero, Bogdan Ignat, Adina Ionac, Dan-Dominic Ionescu, Spain: Manuel Abeytua, Maria Dolores Adarriaga, An- Ricardo Rangel-Guerra, Joel Rodriguez, Ildefonso Ro- Florina Violeta Isai, Octavian Istratoaie, Dragos Cata- tonio Agarrado, Eduardo Jesus Alias, Fatima Al- driguez Leyva, Jose Alberto Rojas, Aldo Romero, Gus- lin Jianu, Emilia Lungut, Cezar Macarie, Liviu Ma- magro, Guillermo Alonso, Jose´ Luis Alonso, Nelson tavo Rubio, Jose Luis Ruiz, Alberto Sagastegui, Oscar covei, Ioan Constantin Marginean, Mihaela Marian, Maria Alvarenga, Luis Javier Alvarez, Amparo Alvarez, Talamas, Monica Tapia, Jose Luis Antonio Toriz Mel- Doina Carmen Marinescu, Liviu Matcau, Costel Ma- Juan Andreu, Jose A. Anton, Juan Carlos Arias Castano, chor, Artemio Uribe, Jorge Vazquez, Jose Antonio tei, Daniela Maria Maximov, Constantin Miliaru, Ioan- Ignacio Artigues, Emilio C. Baldo, Joaquin G. Bau- Velasco, Erich Carlos Velasco Ortega, Raul Gerardo Dan Minea, Adriana Mitre, Mircea Moldovan, Eca- tista, M. Nieves Bellera, Juan Bello, Oscar Beloqui, Jose Velasco Sanchez, Jorge Villarreal. terina Moraru, Carmen Manuela Muresan, Bogdan Maria Bermudez, Miguel Blanco, Juan Carlos Bo- the Netherlands: Wouter Barendregt, Jacob Buth, John Mut-Vitcu, Gabriela Monica Niculescu, Maria Miha- horquez, Alfonso Bolan˜ os, Vicente Brossa, Jordi Bru- Cheng, Anita Dall’ Agata, Jeroen De Haan, Jaap Deck- ela Opris, Cristina-Aura Panea, Ion Pascu, Daniela Mari- guera, Antonio Cabarcos, Purificacion Cacabelos, Marc ers, Jan Driesen, Zoran Erjavec, Albert Funke Ku¨ pper, ana Patru, Marcel Pereanu, Lacramioara Perju- Cairols, Carlos Calvo, Ignacio Camacho, Joaquim Gwan Ho, Josephus Jutte, Koos Keizer, Jan Koning, Dumbrava, Florin Petria, Maxim Petrica, Sanda Canoves, Pere Carbonell, Maria Cruz Carreno, Igna- Steef Kranendonk, Arno Oomen, Evert Sanders, Han Hortensia Petrutiu, Viorel Poalelungi, Mihaela- cio Casado, Jose Ignacio Catalan, Paz Catalan, Aran- Sie, Niek Valk, Ben van Brussel, Marc van Daele, Eric Ruxandra Popescu, Andreea-Catarina Popescu, Damian zazu Caudevilla, Jose Cerda, Pilar Raquel Chamarro,

Alfredo B. Charles, Berta Claramonte, Vicente E. Cli- Didier Giroud, Willy Gross, Christian Haeuptle, Phil- nelly, Michael Duckworth, Jeremy Dwight, Thomas ment, Juan Colas, Pere Comas, Jesus Juan Corro- ippe Haldy, Michael Hany, Elie Hecker, Christophe Egerton, Ian Farker, James Ferguson, Ahmet Fuat, Tim chano, Carlos Culebras, Meliton Francisco Davila, Javier Henny, Markus Hug, Blaise Ingold, Gereon Jachertz, Gietzen, Jonathan Hamling, John Hole, Shervanthi de Andres Novales, Maria del Pilar de Luis, Felix Diaz Olivier Jaques, Se´ bastien Jotterand, Urs Keller, Franz Homer Vanniasinkam, Ivor Hughes, Paul Husselbee, Perez, Ignacio Duran, Jose Antonio Egido, Jose- Kieliger, Aldo Kramis, Mariusz Kraszewski, Andreas Martin James, George Kassianos, Martin Kent, Barbara Bernardo Escribano, Juan Manuel Escudier, Antonio Kuske, Martin Landolt, Markus Lanz, Thomas King, James Kingsland, Michael Kirby, Robin Lalsarin, Espinosa, Raul Espinosa, Jose Ramon Fernandez, Ovidio Limacher, Jean-Francois Luthi, Pierre-Andre Martin, Richard Lawrence, Ping Siang Lee, Mary MacLeod, Gil- Fernandez, Fabriciano Fernandez de la Cigon˜ a, Marta Juerg Niesper, Karl Nuesch, Hanspeter Oechslin, Al- lian Manning, Ross Martin, Carol McKinnon, David Ferrero Ros, Antonio Flores, Rosa Maria Folgado, Franc- bert Pfaeffli, Alexander Pinzello, Michel Pithon, Mi- Douglas McKeith, Dalpatram Mistry, Susan Morgan, esc Formiga, Carlos Franco, Joaquin Franco, Evaristo chael Richter, Thomas Schneider, Hans-Rudolf Sarah Morgan, Michael Page, Basil Francis Penney, Ste- Freire, Moises Galan, Jesus Galiana, Iluminada Gar- Schwarzenbach, Philippe Staubli, Hans Stricker, Louis phen Rowlands, Jagtesh Sharma, Cliff Shearman, Li- cia, Francisco Garcia, Juan Pedro Garcia, Bartolome Tjon-A-Meeuw, Pierluigi Togni, Enrico Tschurr, Paolo onel Sherman, Manish Singh, William Thorburn, David Garcia, Gonzalo Garcia, Jose Maria Garcia, Fernando Tutta, Barbara Vogel Wigger, Irene Von Planta, Daniel P. B. Watson, Alastair Watt, Robert Weir, Peter Sid- Garcia de Burgos, Bernardo Garcia de la Villa, Juan de Vuilleumier, Niklaus Waldis, Jean-Marc Wandeler, ney Wiggins. Dios Garcia Diaz, Juan Carlos Garcia-Mongo, Daniel Yves-Marie Wasem, Josef Widler, Christian Widmer, United States: Coordinating Committee: Larry Brass, Eduardo Geffner, Ricardo Gesto, Juan Miguel Giron, Stephen Woolley, Bernhard Zauner, Andreas Marie Brown, John Cooke, Bruce Coull, Mark Crea- Ignacio Goicolea, Fernando Gomez, Jorge Francisco Z’brun. ger, Michael Criqui, Greg Fonarow, William Golden, Gomez Cerezo, Emilio Gonzalez, Carlos Gonzalez, Taiwan: Lung Chan, Chao-Shun Chan, Chi-Jen Chang, Philip Greenland, Michael Jaff, Pavel Levy, Pat McBride, Alonso Gonzalez, Maria Isabel Gonzalez, Manuel Hung Yu Chang, Chiung-Chih Chang, Ku-Chou Mary McDermott, Elizabeth Ofili, Charles Reasner, Gonzalez, Manuel Gracia-Naya, Gabriel Gusi, Gabri- Chang, Pan Chen Chang, Rei-Yeuh Chang, Jun-Yih Ralph Sacco, Elijah Saunders, Jeffrey Saver, Peter Shee- ela Guzman, Jose Sergio Hevia, Maria Luisa Hidalgo, Chang, I-Chung Chen, Chi-Li Chen, Yu-Wei Chen, Jia- han, Karol Watson. Pedro Horcajo, Maria Ibanez, Ana Idoate, Miguel Ido- Ren Chen, Chih-Wei Chen, Cheng-Yun Chen, Yung- Investigators: Rahat Abbas, Lisa Abbott, David Ab- ate, Jaume Illa Gay, Maria Irurita, Javier Iser, Guill- Ping Chen, Tsang-Shan Chen, Wei-Hung Chen, Yu- dehou, Issa Abedmahmoud, David Abisalih, William ermo Izquierdo, Sergio Jansen, Catalina Jimenez, Blas Hung Chen, Zhih-Cherng Chen, Kuo-Chin Chen, Mei- Abraham, Kenneth Ackerman, John Addo, Angela Ad- Jimenez, M. Dolores Jimenez, Elisabet Junca, Fran- Hsiu Chen, Tain-Junn Cheng, Chih-Hui Chin, Chiung- elizzi, Satinder Aggarwal, Maher Agha, Thordur Agusts- cisco Laynez, Jose Manuel Ligero, Jose Maria Lis, Se- Zuan Chiung, Li-Ping Chou, I-Tseng Chu, Wen-Ting son, Bashiruddin Ahmad, Anwar Ahmad, Sheikh cundino Llagostera, Carmen Llort, Alfredo Llovet, Juan Chung, Chin Shih Fong, Chih-Ping Hsia, I-Chang Hsieh, Ahmed, Dilawar Ajani, Fabricio Alarcon, Cesar Albar- Carlos Lopez, Luis Lopez, Aquilino Lopez de la Osa, Yuankai Hsieh, Jen-Che Hsieh, Ron-Bin Hsu, Ming- racin, Kim Albright, Cesar J. Aleman, Ruben Aleman, Pablo J. Lopez-Ibarra, Francisco Lozano, Maria De Los Chin Hsu, Chin-Fu Huang, Chin-Wei Huang, Yu- Jeffrey S. Alexander, Michael Alexander, Steven Al- Reyes Luna, Jose Luis Macingirar, Juan Manuel Ma- Yau Huang, Jiann-Shing Jeng, Chien-Chen Ko, Wen- exander, Abdul Ali, Hussamaddin Al-Khadour, Deana raver, Jose Maria Marey, Jose Marin, Alejandro Mar- Kai Kuo, Wen-Ter Lai, Chen-Chin Lee, Tsong-Hai Lee, Al-Khateeb, David Allan, Richard Allen, Ronald Alley, tin, Juan Carlos Martin, Elvira Martin de la Torre, Al- Kuan-Hua Lee, Li-Ming Lien, Shinn-Kuang Lin, Ruey- Michael D. Allison, Manohar Alloju, Barnet Alpert, Ir- berto Martinez-Berganza, Manuel Martinez-Perez, Tay Lin, Tin-Kwang Lin, Kao-Chang Lin, Rue-Tsuan fan Altafullah, Reynald Altema, Venkatreddy Alugubelli, Ramon Martos, Jaime Masjuan, Antonio Mateos, Vi- Liu, An-Bang Liu, Huey-Ming Lo, Dee Pei, Shan-Jin Frank Alvarez, Hernando Alvarez, Sandra Alvarez, Gus- cente Medrano, Jordi Merce, Angel Merchante, Ryu, Mao-Lin Sung, Sung-Chun Tang, Shiang Tang, tavo Alza, Saleem Aman, Chimezie Amanambu, Salah Shaghim Mir Davood, Carlos Mirete, Felipe Molina, Wen-Lung Tsao, Kwo-Chang Ueng, Tzung-Dau Amer, Jatin Amin, Kausmik Amin, Narendra, J. Amin, Jose-Manuel Molto, Marcelino-Jesus Montero, Manuel Wang, Shi-Yi Wang, Ko-Yi Wang, Cheng-Yu Wei, Yogeshcha Amin, Maged Amine, David Amos, David Montero, Marian Montero, Pedro Maria Montes, Fran- Ting-Yu (Dean) Wu, Jung-Chou Wu, Wen-Shiann Wu, L. Anders, Charles P. Anderson, William Anderson, Pe- cisco Jose Monzon, Mirem Morillas, Pedro Jose Mo- Shang-Shan Yang, Shoou-Jeng Yeh, Chung-Hsin Yeh, ter B. Anderson, Bruce Andrea, Luis Anez, Satish An- rillas, Antonio Munilla, Ricardo Nicolas, Pedro Niem- Shih-Bin Yeh, Ping-Keung Yip, Bak Sau Yip. gra, Shamshad Anjum, Salwan Anton, Juan Aponte, bro, Rosa Numancia, Enrique Nun˜ o, Fernando Olaz, Thailand: Yupin Benjasuratwong, Watana Boonsom, Vincent Aquino, Dercy Aranador, Peter Arcuri, Abra- Nieves Oller, Juan Ortega, Javier Ortega, Ernest Orts, Wacin Buddhari, Pongamorn Bunnag, Nijasri Charn- ham Areephanthu, Lisa Arian, David Arkin, Jodh Arora, Ana Otero, Antonio Paules, Marco Antonio Paz, Jose narong Suwanwela, Adhisabandh Chulakadabba, Chai- Ansermo Arthur, William J. Artz Jr, Palaniapp Aru- Luis Pen˜ a, Jose Luis Perez, German Perez, Alfonso Perez charn Deerochanawong, Suchat Hanchaiphiboolkol, mugham, Siva Arunasalam, Tanya Arvan, E. David As- Molino, Gonzalo Pia, Josefina Pinedo, Angel Plaza, In- Sopon Jirasiritham, Rungsrit Kanjanavanit, Weerayut carelli, Ralph Ascher, Letterio Asciuto, Wail Asfour, Mo- maculada Plaza, Juan Manuel Pons, Jose Carlos Pon- Khositsakulchai, Songsak Kiatchoosakun, Pornchai hammed Asgar, Susan Ashley, Gerald Asin, Mansour tes, Antonio Portoles, Francisco Poveda, Maria- Leelanipon, Nithi Mahanonda, Samart Nidhinan- Assar, Hatem Ataya, John Atkinson, Frank Attenello, Ignacia Prat, Enrique Puras, Josefa Rasel, Jose Tomas dana, Sirichai Niramaxnsakul, Sumana Nopparat, Larry Atwood, Ducarmel Augustin, Than Aung, Barry Real, Sandra Redondo, Miguel Angel Rico, Andreu Rius, Arintaya Phrommintikul, Chumpol Piamsomboon, Pavit Austin, Howard Axe, Alexander Axelrod, George Josep Maria Roca, Enrique Rodilla, Jose Angel Rod- Pienvichit, Paisith Piriyawat, Niphon Poungvarin, Wilai Aycock, Oluropo Ayeni, Bryce Ayers, Muhammad riguez, Melchor Angel Rodriguez, Javier Rodriguez, Puavilai, Disya Ratanakorn, Tongprakob Siriwanij, Ka- Azam, Nabil Azar, Harvey Azarva, Sueann Babb, Kevin Angel Ciriaco Roldan, Antonio Romero, Jaime Ro- jorn Suntrapiwat, Swangjit Suraamornkul, Saranyou Babin, Oswald Bacani, Umeshkuma Badami, Timo- quer, Julia Roure, Tomas Rubio Vela, Jose Ignacio Ruiz, Suwanugsorn, Sompongse Suwanwalaikorn, Viroj To- thy S. Bailey, Paula Bailey-Walton, Gary Baiocchi, Don- Mariano Ruiz, Joaquin Ruiz de Castroviejo, Martin Ruiz kavanich, Damras Tresukosol, Gumpanart Veerakul, ald Baird, James Baker, Ladan Bakhtari, Robert Bala, Ortiz, Oscar Saavedra, Jose Saban, Josep Sadurni, Luis Apichati Vichayanrat, Visuit Vivekaphirat. Gobivenka Balaji, James Baldys, Jose V. Ballesteros, Saez, Jose Antonio Saenz de Quevedo, Jesus Salas, An- Ukraine: Kateryna Amosova, Svetlana Andri- Pratap Balusu, Chaim Banjo, Ahmad Banna, Tobia Bar- tonio Salvador, Jose Maria Sanchez, Pedro Sanchez, yevskaya, Igor Bereznyakov, Mykola Bezyuk, Olex- bato, Frederick Barber, Harris Barrett, Anthony Bart- Sonia Santos, Julia Saura, Jesus M. Sedeno, Tomas Se- andr Dyadyk, Georgiy Dzyak, Ludmila Dzyak, Boris kowiak, Thomas Barkley, Sara Bartos, Basel Batarseh, gura, Francisco Javier Serrano, Pedro Javier Serrano, Goloborodko, Nataliya Grytsay, Igor Kobza, Oleg Neera Bathija, Ali Bazzi, James L Beach, Thomas Javier Solis, Cristina Soriano, Jose Francisco Sotillo, Ana Korkushko, Olena Koval, Volodymyr Kovalenko, Svet- Beamer, Michael Beane, William C. Beck, Howard Isabel Soto, Carmen Suarez, Mercedes Suarez, Luis lana Kuznetsova, Tamara Mishchenko, Nataliya Mish- Becker, Richard Becker, Steven Becker, Teresa Becker, Miguel Tamargo, Luis Teigell, Jose Maria Trejo, Jordi chuk, Vasyl Netiazhenko, Alexandr Nikonenko, Vadim Gary Bedel, Harjaneet Bedi, Richard Beham, Steven Trulla, David Tura, Miguel Urtasun, Eliseo Val, Mari- Nikonov, Alexander Parkhomenko, Tetyana Pert- Belt, J. William Benge, Dana Bennett, Charles Ben- ano Valdes, Javier Vaque, Fernando Vaquero, Luis Va- seva, Sergey Polyvoda, Yuriy Rodin, Anatoliy Rudenko, nett, Nathan Bennett, Paul Benson, Michael Berard, rona, Antonio Vazquez, Francisco Vega, Alfredo Victor Rudenko, Yuriy Rudyk, Oleg Sergeyev, Yuriy Zoya Berenson, Richard E. Berger, Oran Berken- Velasco, Tomas Vicente, Juan Antonio Vidan, Blanca Sirenko, Yevgenija Svyshchenko, Sergey Sychov, Vic- stock, Gregory Berland, Gary Berman, Yuri Bermu- Vilaseca, Ricardo Vilchez, Irama Villar, Javier Vin˜ as, tor Tashchuk, Igor Vakalyuk, Stepan Vinychuk, Vadim dez, Seth Bernard, Jay Bernstein, John F. Berry, Rob- Guido Volo, Manuel Jesus Zarauza. Vizir, Vladimir Volkov, Leonid Voronkov, Andriy Yagen- ert Bevill, Ravi Bhagwat, Adarsh Bhat, Harry S. Bhatia, Switzerland: Gilbert Abetel, Franco Ackermann, Nicola sky, Valentina Yavorskaya. Dinesh Bhatia, Anil Bhatia, Divyesh Bhatt, Jayantilal Alexander-David, Piero Andreoli, Michel Badan, Bruno United Arab Emirates: Aboobaker Abdul Rahuman, Bhimani, Paul Bicek, Sandy Bidner, Robert Bierman, Boillat, Hans-Juerg Bopp, Ruedi Bosshardt, Heinrich Sherif Bakir, Nooshin Bazargani, Azzan Binbrek, Dan Bieser, John Biggers, Barbara Biggs, Smita Bij- Budmiger, Reto Cadisch, Philippe Chapuis, Haw- Galal Eldin Elkilany, Jihad Inshasi, Deeb Maxwell lani, Ilya Bilik, Alan Bilsky, Karla L. Birkholz, Ishak Bis- Tzer Chen, Yves Collioud-Robert, Josy-Philippe Cor- Kayed, Christian Lange, Adel Wassef, Tayseer Zein hara, Veita Bland, Benjamin Blank, Kenneth Blaze, Mi- nut, Jean-Pascal Croci, Philippe Delorme, Roberto Elabdin. chael Bleiman, Scott Bleser, Daniel Blizzard, Ronald Gianni Di Stefano, Urs Duerst, Dominique Durrer, Urs United Kingdom: Malcolm Addlestone, Rajendra Agar- Blonder, Craig M. Bobson, Donald Bodemann, Ste- Enggist-Rueesch, Marco Facchini, Heinrich Ch Flueck- wal, Richard Barker, Anthony Barnett, Balasubrama- phen Bodemann, Timothy Boehm, Nancy Bohan- iger-Keller, Antoine Frangos, Felix Fust, Markus Gal- niam Baskaran, David Bowen-Jones, Andrew Brooks, non, Paul Boinay, Gregory Bojrab, Anu Bommareddi, lati, Didier Genond, Alfred Gerber, Alberto Ghirlanda, James Ronald Courtney, Philip Cummin, Richard Don- William M. Bond, Dana Bonezzi, Jonathan Bornfre-

E6 JAMA, January 11, 2006—Vol 295, No. 2 (Reprinted) ©2006 American Medical Association. All rights reserved. REACH REGISTRY INVESTIGATORS und, Joseph F. Bornheimer Jr, David T. Borowski, Rob- Richard M. Dupee, Antonio Durazo, Theodore East- Hilton, Edward Himot, Aref Hindawi, Ralph Hines, Su- ert Borrego III, Peter Bottar, Alix Bouchette, Craig Bou- burn, Andrew M. Ecker, Joseph Eckert, James Ed- san Hirtz, David L. Hitz, George Hnatiuk, Marion Ho, dreaux, Max Boune, Jean-Claude Bourque, Robert L. wards, Troy Edwards, Richard Egan, Alan Egelman, Vincent Ho, Henry Hofbauer, Barbara Hoffman, Daniel Bowling, Cherry Brandstater, Gary Breen, Ray Breiten- Christopher Ehly, Joseph Eickmeyer Jr, Zamir Eidel- Hoffman, Mark Hoffman, Joseph Holik, David Hollis, bach, Arnold J. Brender, Peter Bressler, Donald Brideau, man, Bruce M. Eisenberg, Gilbert Eisner, Richard A. Kenneth Hong, Laura Hong, Peter Honig, Michael Timothy J. Bright, Alan J. Briker, Chandra Britt- Elias, Arthur Elkind, Russell Emerson, Jay Enders, Mi- Hood, Bryan Hooker, David Hooks, Arnold Hopland, Armstrong, Harry Brodie, Michael Brodowski, Neil chael Englund, Richard Enns, Julio A. Enriquez, Thomas Stanley Horowitz, John House, Jerome Howard, War- Brodsky, Barry Bronstein, George A. Brooks, Carman Epperson, Gurol Erbay, Kent Erickson, James Eisen- ren Hoyt, Ewa Hozakowska, Jui-Chinh Hsu, Yiling Brooks, Gilbert T. Brovar, James Brown, Kevin Brown, menger, Oliver Eshenaur, William Espinoza, Nordeli Huang, Daniel Hubbard, Yolanda Huet Vaughn, Mi- Gary Brunkow, John E. Brunner, Michael Buben, Hec- Estronza, Manoharan W. Eustace, Bryan Evans, Pa- chael Hugar, Garland Hughes, In Huh, Terrill Hulson, tor Buch, Robert Buckingham, Ernesto Buencamino, tricia Fahey, Fayaz Faiz, Alik Farber, Hussam Far- Richard Huntley, Joan Hurlock, Nizar Hussain, Am- Ronald Buening, Angela Bully, Richard Bultman, Noor houd, Joseph Farmer, Mark Faron, Debra Fast, Sta- anda Huver, Anthony Iannamorelli, Syed Imam, Gre- Bunney, Brian Buoscio, John Burch, Max Burger, John cey Fazenbaker, G. Thomas Fazio, Kathleen Fearon, gorio Imperial, Young In, Fred Ingram, Carlos Inocen- Burkard, James Bush, Richard Butcher, Susan Butler- Daniel P. Featherston, Michael Fedak, Hailing Fei, Brian cio, Kam Ip, John Irvin, John Irvine, Armen Isaiants, Sumner, Robert J. Buynak, Joseph G. Cacchione, Al- Feingold, Greg Feinsinger, Bryan Feldman, Francis M. George Isajiw, Harold Isenberg, Gregory Isenberg, Tet- vin Cacho, Daniel Cadigan, David Cahn, Robert Cai- Felice, Afonso Ferreira, Dennis P. Fielding, Carolyn suo Ishimori, Gary Ishkanian, Rodney Ison, Ricardo Issa, fano, Roy Caivano, Beverly Calkins, Daniel Cameron, Fields, Ramon Figueroa, Alan Fine, Brian First, Jerome Laxman Iyer, Henry Izurieta, Stephan Izzi, Mark Izzo, Sumner Camisa, Deborah Camiscoli, Jeanne Camp- Fischer, Joel Fischgrund, Richard Fishman, Eugene Fish- Nabil Jabbour, Byron Jackson, John Jackson, Michael bell, David R. Campbell, Robert Campbell, Martin Ca- man, David B. Fittingoff, Kelleen Fitzgerald, Mark R. Jackson, Richard A. Jackson, Robert Jackson, Prema perton, James P. Capo Jr, Angelo Cappiello, Anthony Fitzgerald, David Fitz-Patrick, Patrick Flamion, Thomas Jacob, Walter Jacobs, Sushil Jain, Ashok Jain, Jas- Caputo, Richard A. Caputo, John Caras, James E. Car- Flanagan, Susan Flanzman, Jerrold Flatt, Leslie R. want Jain, Herbert Jalowsky, Kassamali Jamal, Rob- ley, Leonor Carluen, David Carmouche, Richard Caro, Fleischer, Diane Flershem, Adolph Flowers, Pau K. ert Jansen, Robert Jeanfreau, Ronald Jeffreys, George Kent Carpenter, Kyle Carter, Glenn Carter, Steven Fong, Robert Foster, Dana Fouchi, Donald Fowler, Jenckes III, Paul Jennewine, Albert Johary, Kenneth Carver, Terrance Castor, Samuel D. Caughron, George David Fox, John Fox, Carol Frank, George Frank, Ron- Johnson, Carol Johnson, David Johnson, M. Blaine Cavanaugh, Patricia Cavero, Lee Celio, Robert Ce- ald Frank, Matthew Frankel, Michael Franklin, Elliott Jones III, Rebecca Jordan, Elaine W. Joslyn, Jeffrey Ka- vasco, Vijay Chadha, Jyoti Chakravarty, Donna Cham- Franks, Jerome Franz, Daniel Freberg, Jeffery M. gan, Bruce Kahan, Scott Kahney, Amy Kaissar, Ste- bers, Becky L. Chandler, Michel Chapnick, Arthur Char- Freesemann, Donald Frein, John B. Freitas, Greg French, phen Kajencki, Venu Kakarala, Sambamurty Kala- matz, Maria Charron, Michael Chaskes, Ignacio Chaves, Craig Freyer, Jack Friedel, Richard Friedlander, Ed- hasty, Nedzat Kalici, Luda Kamenetsky, Michael Kamiel, Opkar Chawla, Kuan-Cheng Chen, Chung-Kwang ward Friedman, Linda Freilich, Samuel Frumkin, David James Kammerling, Ramesh Kania, Ira Kaplan, Marc Chen, Eric Cheng, Tien Cheng, Yuri Cherny, Indira Fuentes, Joseph Fuller, Frank Fusco, Denise Fuson, Kaplan, Richard Kaplan, Khalid Karim, George Karkar, Chervu, Thomas Chesar, Salomon Chesoni, David Manu Gadani, Pravin Gadani, Nitin Gaikwad, Marc David Karty, Randy Karu, Jerome J. Kastrul, Mulraj N. Chess, Peter Chhabria, Michael Chidester, Anthony Gaines, Anthony Gaither, Peter Galvan, Melissa Gam- Katira, John Katsetos, Charles Katzenberger, Steven Chieffalo, Oscar L. Chien, Danny Chin, Angelo Chin- ponia, Arvind Gandhi, Jyoti Gandhi, Bhupendra Gan- Katzman, Ronald Kaufman, Bruce Kauk, Morton nici, Donald Chisholm, Olethia Chisolm, Ronald H. dhi, Ramon M. Garcia-Septien, Jeffrey Garb, Shyrelle Kavalier, Tahoora Kawaja, Susan Kawakami, Mark Kay- Chochinov, Suk Choi, Myunghae Choi, Jatinder Cho- Gardner, David Garfias, Marcus Garfield, Ram Garg, lin, Marta Kazymyra, Allan Kelly, Richard Kelter, Nancy pra, Nakchin Chung, Robert Ciemiega, Michael Cirilli, James Garner, David Garretson, David Garrett, David Kenney, David Kenton, Jayanth Keshavamurthy, Ronald Ciubotaru, Frank A. Civitarese, Louis A. Civi- Garza, Irvin J. Gastman, Simon Gebara, Lakhabhai Ge- Damoder Kesireddy, William Kessler, Clarita Ketels, Na- tarese, Daniel Clark, Dennis Clark, William Coburn, dia, James Gehant, Steven Geller, Willis Gelston, sir Khalidi, Anila Khan, Misal Khan, Muhammad Khan, Steven L. Cochran, J. Louis Cohen, Loren Cohen, Shari Mikhail Gendel, Shawn Gentry, William George, Mat- Waqar Khan, Yervant Khatcherian, Audisho Khoshaba, Cohen, Susan Colbert-Threats, Ronald Cole, Gary Cole- thew George, Robert Geronemus, Luis Gersten- Rakesh Khosla, Samia Khwaja, Gary Kiefer, Peter Kiefer, man, Scott L. Coleman, Maha Coles, James Coma- meier, Donald Giant, James E. Gibbs, Francisco Gil, Doug Kim, In Kim, Seong Kim, Alan Kimmel, Ganesh zzi, Barry Conlan, Michael Conrad, Sean Conroy, Se- David L. Gilbertson, Michael Gilinsky, Satpreet Gill, Roy Kini, Mark Kipnes, Joseph Kipp, Nicholas T. Kipreos, bastian Conti, Richard Cook, Nelson Cook, J. Paul Gillick, David Gilliam, Eugene Gillman, Mary Gindi, William Kirby, Robert Kleinhaus, Ken Kleinsteuber, Cook, Joseph Cook IV, David L. Cooley, Daniel Coo- George Gindi, Linda A. Glaser, James Glass, Elyse Martha Klipec, Alexander Klufas, James Knecht, Her- per, Michael Cooperman, Jerry Cope, Danny Cor- Glazer, Boris Gliner, Jan Glowacki, Eugene Go, James man Knoll, Gloria Ko, Howard Koch, Stanley Koch, Pe- ales, Bernard Corbett III, Edward Coreil, George Cor- Goetz, Ramnik Gokani, Burton H. Goldberg, Ronald ter P. Koenig, Charles Koepke, Keith Koepke, Valeri nett, David Cossman, Susan L. Courtnage, Louis Cox, Goldberg, Joshua Goldman, Stephen Goldner, Daniel Koganski, Asha Kohli, Sanjeev Kohli, Gary Kolanch- William Cox, Michael Cox, Yvette Crabtree, Johnetta Goldsmith, Arnold Goldstein, Francis Goldstein, Rob- ick, Kenneth Kollmeyer, Richard Kondan, Walter Kop- M. Craig, John Crider, James Crider, Edgardo Crisos- ert Goldstein, William A. Gonzales, Julian Gonzalez, pel, Walter Koppenbrink, Bonnie Koreff-Wolff, Na- tomo, Michael Cromer, Jon Cronin, Janna Crosnoe, Miguel Gonzalez, Diane Goodale, Peter Goodfield, talia Kovtun, Denise Kraft, Hal Kramer, Lawrence Irene L. Cueto, Frank E. Cummins, Chackumkal Cyriac, Daniel Goodman, Anil Gosalia, John Gosling, Atul Gos- Kramer, Melvin Kramer, Michael Kramer, Sybil Kra- Rebecca Dailey, Samuel J. Daisley, Gloria Damien, Keith wami, Daniel Gottlieb, Otto Goyco, Neil Grabenset- mer, Steven Krems, Marc Kress, Barry Kricsfeld, Anath Damsker, Bhuvanesw Dandapani, Tze-Yu Dang, Chris- ter, James Grady, Kurt Graves, Victoria Greblya, Ran- Krishnan, Muthu Krishnan, Robert Kroopnick, Prathibha tine Darwin, Suresh Dasani, Leonard Dimitri Dasilva, dall Green, Robert Green, David Greenberg, Martin Kumar, Rakesh Kumar, Satesha Kumar, V. Hema Ku- Robert Dausch, Amita N. Dave, Kamlesh Dave, Roger Greenfield, Robert M. Greenfield, Steven B. Green- mar, Anita Kundra, Michael Kunkel, Anthony Kurian, Davidson, Gregg Davis, Kenneth Davis, Pamela Davis, man, Mitchell Greenspan, Paul Griffel, Daniel Griffin, Richard Kurtz, Scott Kurzrok, Donald Kushner, Muthu Paul Davis, Regina Davis, Sakina Davis, William Davis, Corinne Griffith, Howand Grill, William S. Gross, Ter- Kuttappan, Tim Kval, Peter Kwon, Stella Kwong, Jo- Hursie Davis Sullivan, Thomas M. Dawes, Mark Daw- esita Guanzon, Michael Guice, Carolyn Guidot, Ro- seph Labuda, Bruce Lachterman, Anthony Lacorte, son, Dominador L. Dayon Jr, Praxedes M. Dayon Jr, hit Gulati, Franklin Guneratne, Suresh Gupta, Mi- Jerome Lacy, David Lahasky, Vinodrai Lakhani, Ha- Nirmal K. De, Armando de Feria, Mario de Meireles, chael Hack, Everold Haffizulla, Farzanna Haffizulla, beeb Lakhani, Aristotel Laliotis, Chad Lamb, Jose Lami, Jose de Souza, Don Dearmitt, Susan Debin, Gordon Jason Haffizulla, Joel Hagedorn, Jeffrey Haggenjos, Suman Lamsal, Carl Lang, Alan Langburd, Lorlyne Decker, Ernest Defazio, Ross del Fierro, Bernardo Dela- Steven Hall, Roger Hallgren, Betty Halpern, Alan Lange, Anthony Lanier, Rita Laracuente, Aurorita Lari- guardia, Eliezer R. Deleon, Christine Delgaizo, Salva- Hamilton, Maxine Hamilton, Todd Hammond, Jew- osa, Joseph Lash, Alan Lau, Marshall Lauer, David Bruce dor Delrosario, Joseph Deluca, John A. Demopulos, ell Hamner, Glenn Hamroff, Min-Yen Han, Forrest Laughlin, Christopher Lavergne, George Lawrence, Michael Dempsey, Marvin Den, Michael Denker, Paul Hanke, Beth Hanrahan, Eric Hansen, Richard Han- Theodore Lawson, Milenko Lazarevic, Kadie Leach, Denker, Kevin Denlinger, Garth Denyer, Shivinder S. sen, Charles Hanshaw, Mike Harless, Michael D. Har- Richard Leavitt, Marc Leblanc, Cristina Lecaros- Deol, Gustavo Depetris, Pankaj R. Desai, Jay- ris, Nita Harris, Roy W. Harris, Stephen Harrison, Mat- Trinidad, John Ledbetter, Chok Lee, Dae Woo Lee, Joe aprakash Desai, Anthony Detulio, Denise Dever- thew E. Hart, Paul Hartley, Daniel Haspert, Joseph Lee, John Lee, Karl Lee, Kenneth Lee, Nellie Lee, Tat- anez, Gary Devoss, Chrisette Dharma, Ricardo di Sarli, Hassan, Irfan W. Hassen, Roger Hatharasinghe, Tabas- Sum Lee, Leonard Lefkovic, Anthony Leone, Eric Ler- Richard Diamond, Steven Diamond, Sam Diasti, Franco sum Hatimi, Martin Hauptschein, George C. Hawrot, man, Keith Lerner, Stephen Leshin, Ying-Yan Leung, Diaz, Martiza di Diaz, Susan Dickson, James Dieth- Richard Hays, George Gilbert Head, Luis Heffess, Ole David Levenson, Phillip Levin, Marc Levine, Brian Levy, elm, Michael Dietz, Patricia Disharoon, John Dixon, Heggeness, Jeffrey Hein, Philip Heinegg, Maryam Hek- Meldon Levy, Richard Levy, Marc Lewen, Randal Lewis, Michael Dobish, Christopher Dobrose, Douglas Doc- mat, Richard Hellman, Hal Hemme, Stephen Hender- Gary Lewison, Charles Li, Mark Li, Michael Li, Rog- tor, Heman B. Dodani, Larry Doehring, Frederick son, Gregory Henes, Mario Henriquez, David Henry, elio Liboon, David Lick, Laurence Lief, Cyril Light, An- Doerfler, Paul Donnan, James Donovan, Larry Doro- Aravind Herle, Paul Hermany, Adan Hernandez, Car- drew Lim, Dee Beng Lim, Florian R. Limjoco, Shiann show, John Dorsey, Natalie Doyle, Gerald Dreslinski, los R. Herrera, Moses Herrera, Robert Herrera, Ste- Lin, Jeffery Lindenbaum, Edward Linkner, David Li- Netley D’Souza, Pamela Dugano-Daphnis, Narindar phen Herrington, Jeffrey Hershkowitz, Phillip Hertz- porace, Orrin Lippoff, Jefrey Lipsky, Robert Lira, Daniel M. Duggal, Jennifer Dunbar, Katherine Dunleavy, man, Peter Herz, Steve Hiland, Stephen Hillis, Daniel H. Lischwe, Scott Lisse, Jiang Ping Liu, Paul Liu, Hedy

Loa, Cherry B. Lobaton, Fransisco Lopez-Arostegui, Fredirck Payne, Brenda Peabody, Mark Peacock, Gregg Sing, Lakheram Singh, Sarupinder Singh, Vineet Singla, Peter Lopresti, Juliette Louis-Charles, Joseph Lovato, Pearson, Anthony Pearson, John Peet, Jose Pelayo, Car- Prabhat Sinha, Hicham Siouty, Kanagarat Sivalingam, Florentino Loya, Herbert Lubowitz, David Luck, Mark men Perez, Nathan Persoft, Mark Peschiera, Koster Walter Skowsky, Stan Slabic, Alex Slandzicki, Juris Lueg, Jorge Luengas, Manuel Luna, Jerry Luoma, Le Peters, Cornell Peters, Dennis Peterson, William Petit, Slesers, Lance Sloan, Steven Smallow, Albert Smith, Le Luu, Robert L. Lycksell, Lon Lynn, Gregory Lyon- Charles Pewitt, Tri Minh Pham, Charles W. Phelps, Gary Scott Smith, George Smith, Howard Smith, Jack Loftus, Sherry Ma, Shahrad Mabourakh, Michael Mac- Gregory J. Phillips, Frank Pintauro, Kenneth Pittle- Smith, James Smith, Janet Smith, Kenneth Smith, Mu- adams, James Mackenzie, James Mackrell, Roger Mad- man, Gerald A. Pitzl, Lester Ploss, Ethan Podet, David hammad Smith, Ruth Smothers, Bruce Sobel, Celeste ris, Richard Maffezzoli, James Magee, Robert Pogue, Craig Polinsky, Jeff Pollock, Daniel Pom- Soberano, Todd Sobol, Barbara Socha, Carl Sofley, Na- Mahaffey, Aparna Mahakala, Yugal Maheshwari, Sha- posini, Joseph Pongonis, Vicken Poochikian, Gary Post, lin Soni, Om P. Sood, William Soper, Rodolfo ban Mahmoud, Gerald Mahon, Francisco Maislos, Greg Potts, Kevin Pounds, Francis Powers, Amy Prack, Sotolongo, Sun-Chung Soung, Paris Spanolios, An- Prakash Makam, Louis Maletz, Manuel Malicay, Louis Eric Prack, Jan Prasad, David Prelutsky, Larry Pre- gelo Sparagna III, Lisa Speck, Gary Spector, Robert Malinow, Stanford Malinow, Steven Malkin, Ashith sant, Jennifer Prescott-Coraggio, John Prosser, Rodolfo Spees, Paul Spilseth, David Spingarn, Wanda Spunter, Mally, Jonathan Maltz, Martin Malz, Joselita Man- Protacio, Joan Prouty-Moore, Bernard Proy, Haresh Karen Squire, Jagwinder Sraow, Indra Sriram, Eileen alac, Richard Mandel, Barbara Mandell, George Manja, Punjabi, Priya Punjabi, Alan Purdy, Raman Pu- Stade, Steven Staehling, Douglas Stafford, Richard Steven Manuli, Raouf F. Maoud, Teresita Maqueda, righalla, Uma Purighalla, Anthony Purpura, Hoyte Pyle, Staller, Sheldon Staller, Jeffrey Stalnaker, Ian Stamp, Padmanabh Maramreddy, Isam Marar, David Mar- Kamran Qureshi, Diana Rabadi-Marar, Zenaida E. Michael Stark, Samuel Steele, George Stefanos, Paul golis, James Margolis, Michael Margolis, Steven Mar- Racho, Amin Radparvar, Gordon Rafool, Prema Ra- Stein, Gregory Stevens, Jewel Stevens, H. Edwin Stickle, golis, Eric Marks, Stephen Marsh, Real Martin, Larry ghu, Chengalro Raghunathan, Suresh Raheja, Adee- Donald Stillwagon, Randall Stoltz, Grace Stonerock, Martin, Danny Martin, Deogracias Martinez, Edu- bur Rahman, Nader Rahmanian, Mohammad Mark Storey, Helen Story, Michelle Stram, Robert ardo Martinez, Richard Martinez, Scott Massien, Nos- Rahnama, Marina Raikhel, Paavan Railan, Jon Rainey, Straub, Dan Streja, Clement Strumillo, Robert Strzinek, rat Massih, Aziz Masud, Joseph Matheu, John Mathew, Yoshana Rajaratnam, Ganesan Rajasekaran, Kumar Richard Stuntz, David Subich, Marivic Sumulong- Mark Matthias, Elizabeth Mattson, Percy May, Eric Ramdas, Pedro Ramirez, Lucila Ramiro, Loakhnauth Tomacruz, David Sundheimer, David P. Suresh, John Maybach, David A. Mayer, Miguel Mazariegos, Der- Ramkishun, Richard Randolph, Shashikant Rane, Mal- Surso, Michael Suter, Joanna Swauger, Todd Swick, villa McCann, David McCarty, Brent McEntire, Pa- lapur Rao, Rafik Raphael, Joshua Rassen, Nita Ras- William Swofford, Martin Szanto, Henry Szelag, J. Si- trick McLeroth, Steven McAllen, Edward McCarthy, togi, Max Rattes, Frank Rauzi, William Rawlings Jr, San- mon Szeto, Alan Tannenbaum, J. Ross Tanner, Steven Thomas E. McCauley, Thomas McClure, Jeremy jay Ray, Lori Reaves, Salvador Recio, Michael Redding, Tatar, Titus Taube, Robert Taxin, Dawn Taylor, Jack McConnell, Boyd McCracken, Dee G. McCrary, Chan- Nagaratina Reddy, Pankaj Reddy, Ramesh Reddy, Su- Taylor, Joseph Taylor, Leroy Taylor, Miriam Tedder, dler McDavid, Camille McDonald, Richard McEwan, kanya Reddy, Venkat Reddy, Gregory Reed, Jonathan Albert Q. 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Ed- Ronald Underwood, Enrique Urdanivia, Joji Urlanda, Thomas Milko, Eugenia Miller, Jason B. Miller, Linus ward Rosenthal, Benjamin Rosin, Anthony Ross, David Mark Vacker, Richard Vail, Jorge Vallecillo, George van Miller, Michael Miller, Paul Miller, Randall Miller, Steven Ross, Glenn Ross, Jack Ross, Richard Ross, Jeffrey Weelden, John Vandam, John Vanderzyl, Laverne Miller, Guy Mintz, Milton Mintz, Bhagwan Mirchan- Royce, Mylene Rucker, Goran Rudic, Edward Rufus, Vandewall, Bruce Vanvranken, Ronald Vargo, Chan- dani, Suresh Mishra, Sushil Mittal, Shalender Mittal, Robert Ruxin, Joseph Rybicki, Oswald Saavedra, Du- drasekhar Varma, Ronald Varns, Dipak Vashi, Sergio Jon Miyakawa, Amanda Modesta-Keyhani, Pratibha san Sabol, Deepti Sadhwani, Harish Sadhwani, Farid Vega, George Venhuizen, Srividya Venkataraman, Modi, Tushar Modi, Rita Mody, Palghat Mohan, Syed Sadr, Bradley Sakran, Kaori Sakurai, Peter Saliba, Ira Devinder Verma, Kewal Verma, Raman Verma, Yash Mohsin, Martin D. 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