Participants with known cardiovascular, metabolic or pulmonary disease or with ???1 signs or symptoms of cardiovascular, metabolic or pulmonary disease (e.g., pain or discomfort in the chest or other areas that may result from ischemia, shortness of breath at rest or with mild exertion, dizziness or syncope, orthopnea or paroxysmal nocturnal dyspnea, ankle edema, palpitations or tachycardia, inter