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Most clinical hypotheses regarding treatment of cardiovascular diseases have been tested in clinical trials which assume homogeneity of patients around the world. When we seek differences between individual people, we can identify each person by his/her specific face and body shape. However, in the broadest sense, most people look quite similar no matter whether they live—the vast majority are size 1–2 m in height, have a body weight of 40–100 kg, eat vegetable/meat/fish, breathe oxygen and so on. The similarity in people around the globe becomes even clearer when we focus on patients with the same disease, such as atrial fibrillation (AF). The vast majority of patients with AF are aged 60–100 years, approximately half are male (or female), and comorbidities such as hypertension, overweight and diabetes are common. This homogeneity in patient groups leads us to believe that the results of global clinical trials will be applicable to the majority of patients around the world, no matter where they were born or where they are living. We have used data from clinical trials to successfully change the ‘standard of care’ for ‘average patients on the globe’ with various cardiovascular diseases including acute coronary syndrome, heart failure and atherosclerosis/thrombosis. In doing so, we have assumed that patients recruited in ‘global’ clinical trials represent the ‘average patient’ …
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