Events during the interventional part of the study were evaluated with the use of the original outcome-assessment method (adjudication by a committee whose members were unaware of the study-group assignments), although data regard- ing a few major cardiovascular events and deaths in patients who missed their final study visit during the last 6 months of the intervention were captured from central databases (see the Additional Details on End Points section in the Supplementary Appendix). During the observa- tional follow-up period, heart attacks, strokes, and new or worsening congestive heart failure were identified by means of the primary discharge diagnosis in VA or CMS registry files (which have been shown previously to have excellent positive predictive value)15,16 or by review of out- side records in the case of participants younger than 65 years of age who reported an event on their survey, as described above. New or worsen- ing congestive heart failure was identified by means of the primary discharge diagnosis in the CMS or VA data registry or by an ejection fraction of less than 40% as observed on echocardiography