Patient ID
Clinical Center (A-D)
Randomization Date
Study Group (1-6)
Age (y) at Randomization
1=Male 2=Female
Birth Date
Income - Form 25 Q4
Marital Status - Form 25 Q5
Education - Form 25 Q6
Ever Smoke Cigarettes (1=Y, 2=N)
Now Smoke Cigarettes (1=Y, 2=N)
Height (inches)
Visit Date at 12 Months
Weight (lbs) at Baseline
Weight (lbs) at 12 Months
Diastolic BP at Baseline
Diastolic BP at 12-Months
Systolic BP at Baseline
Systolic BP at 12-Months
30 Second Pulse at Baseline
30 Second Pulse at 12 Months
Total Cholesterol at Baseline
Total Cholesterol at 12-Months
HDL Cholesterol at Baseline
HDL Cholesterol at 12 Months
Blood Glucose at Baseline
Blood Glucose at 12 Months
F140 Q10c Drowsiness-12 MO (Values 1-4)
F140 Q10d Tiredness-12 MO
F140 Q10f Faintness-12 MO
F140 Q10l Itchy Skin-12 MO
F140 Q10m Skin Rash- 12 MO
F140 Q10p Headaches- 12 MO
F140 Q10q Ringing in Ears- 12 MO
F140 Q10r Stuffy Nose- 12 MO
F140 Q10v Dry Mouth- 12 MO
F140 Q10x Cough- 12 MO