Table 2 Definition of CVD events as parts of the primary outcome

Acute myocardial infarction:

 Clinical signs and symptoms such as chest pain or cardiogenic shock, associated with abnormalities in biomarkers (creatine kinase, troponin, etc.) and/or electric cardiogram (new abnormal Q-wave, ST elevation, etc.) for myocardial infarction

Congestive heart failure:

 Congestive heart failure (NYHA grade III or IV) requiring hospitalization, excluding dyspnea due to non-cardiac causes (bronchial asthma, etc.)

Stroke:

 Rapidly developing clinical signs of neurological deficit attributable to a focal and/or total brain functions, without clear causes than vascular origin, lasting for more than 24 h or leading to death (if not interrupted by surgical operations or death). Stroke includes subarachnoidal hemorrhage, intracranial hemorrhage, and cerebral infarction but excludes transient ischemic attack, cerebrovascular disease due to hematological disorders (leukemia, polycytemia vera, etc.), primary brain tumors, and metastatic brain tumors. Stroke secondary to trauma is also excluded

Aortic dissection/rupture:

 Clinical symptom of chest pain and/or abdominal pain, and diagnosed with imaging test such as contrast enhanced computed tomography

Amputation of ischemic limb:

 Major amputations at ankle joint or proximal as treatment for patients with symptom and/or signs of lower extremity ischemia

Cardiac sudden death:

 Unexpected death from a cardiac cause that occurs within one hour of symptom onset (witnessed) or within 24 h of last being observed in normal health (unwitnessed)