Assen R Goudev

• Prof.
• Head of Department at Medical University of Sofia

Background Acute decompensated heart failure (ADHF) is often linked to central sleep apnea (CSA), a condition that exacerbates cardiovascular strain and reduces quality of life. In ADHF patients, CSA leads to recurrent nocturnal oxygen desaturation, increased apnea-hypopnea index (AHI), and Cheyne-Stokes respiration episodes, all of which elevate h...

Background Atrial cardiomyopathy (AtCM) encompasses patients with diverse demographics and comorbidities. This study aimed to identify phenotype groups with similar clinical characteristics, compare their mortality and atrial fibrillation (AF) event rates, and assess predictors of mortality. Methods and Results We performed a hierarchical cluster...

Background: Managing acute decompensated heart failure (ADHF) is complex, particularly when combined with comorbidities like sleep apnea. Effective treatment requires personalized approaches, focusing on quality of life (QoL) and mental health outcomes. Purpose: This study explored the prevalence and characteristics of sleep apnea in patients with...

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia, where the focus of echocardiographic evaluation is the left atrium (LA), as a substrate for the arrhythmia(1). But AF is not only a disease of the LA, it also affects the right atrium (RA) (2). Available data on structural changes of RA in AF are scarce, and even more in rel...

Cardiac amyloidosis, once considered a rare disease, is a severe and progressive cardiomyopathy characterized by extracellular deposition of misfolded proteins in the ventricular myocardium. Early diagnosis of cardiac amyloidosis is essential for improving patient prognosis, as it allows for a broader range of therapeutic options that can enhance o...

Introduction: Atrial fi brillation is the main etiological factor leading to the development of atrial cardiomyopathy (ACM). The different types of atrial fi brillation (AF) are characterized by varying severity of atrial dysfunction, symptoms, and prognosis. Objective: The aim of our study is to analyze the echocardiographic parameters of patients w...

Background: The prevalence of obesity and hypertension among healthcare professionals has been previously described. Both diseases are known risk factors for atrial cardiomyopathy (ACM), a new clinical entity with potential to be a determinant of heart failure, atrial fi brillation and thromboembolic complications. In this perspective, early prevent...

Transthyretin amyloidosis (ATTR) is a systemic disease characterized by the deposition of amyloid fi brils in various tissues, leading to progressive neurological manifestations and the development of cardiomyopathy, necessitating timely diagnosis and treatment. This article presents a clinical case of a 74-year-old patient with hereditary transthyr...

Background: Acute decompensated heart failure (ADHF) is often associated with central sleep apnea (CSA), which exacerbates cardiovascular strain and impacts quality of life. In ADHF patients, CSA contributes to recurrent nocturnal oxygen desaturation, elevated apnea-hypopnea index (AHI), and frequent Cheyne-Stokes respiration episodes, increasing h...

Background: Arterial hypertension is the most common factor for structural and functional changes in the heart, but these changes are observed in more advanced stages and in patients with poor control of arterial hypertension. Echocardiography plays a key role in detecting these changes, but a more detailed assessment is needed to identify early ch...

Systemic lupus erythematosus is a chronic autoimmune disorder affecting predominantly young women. Cardiac involvement in systemic lupus erythematosus is common and the typical manifestations are pericarditis, myocarditis, valvular disease, coronary artery disease, cardiac arrhythmias, and congestive heart failure. Clinical lupus myocarditis typica...

The individual approach in the treatment of heart failure (HF) and personalized medicine have been the main topic in recent years in all scientific forums. The combination of chronic obstructive pulmonary disease (COPD) and sleep apnea (SA) further complicates the clinical presentation in patients with HF. The overlap of all three diseases requires...

Introduction: Trimethylamine-N-oxide (TMAO) is a metabolite produced by intestinal microbiota. It is well recognized as an independent risk marker for cardiovascular and renal diseases and mortality. Aim: The aim of the present study was to investigate the effect of Lactobacillus plantarum GLP3 supplementation on TMAO levels in 30 patients with a h...

Introduction: Patients with diverse demographic and clinical characteristics and comorbidities are included in the category of atrial cardiomyopathy (ACM). Aim: Our study aims to evaluate the demographic, clinical, laboratory, and echocardiographic parameters of patients with ACM and to assess their impact on prognosis. Materials and methods: Only...

Background Atrial cardiomyopathy (ACM) is a new clinical entity with significant importance, because of its potential to be a determinant of heart failure, atrial fibrillation and thromboembolic complications¹. Defining different atrial phenotypes is challenging, because of the lack of consensus for the diagnosis of ACM²'³. Menopausal transition is...

Background Atrial cardiomyopathy (ACM) includes patients with heterogenous demographic characteristics and comorbidities. Defining phenotype groups with similar clinical characteristics is important for the effective treatment of these patients, and for their prognosis and prevention of ACM. Purpose To conduct a cluster analysis that could help us...

Introduction: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a severe progressive disease, more common than previously expected. The main objectives were to evaluate hereditary and wild type ATTR-CM frequency and clinical manifestations. Material and methods: One hundred seventy-eight patients at mean age 68 ± 13 years (129 males), referred by c...

Aims We hypothesized that the current gold standard for risk stratification of patients with acute heart failure (AHF), the Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF (MEESSI‐AHF) risk score, can be further improved by adding systemic inflammation as quantified by C‐reactive protein (CRP). Meth...

Background and Aims It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs—diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk p...

Background: Trimethylamine N-oxide (TMAO) is synthesized by the intestinal microbiota and is an independent predictor of cardiovascular disease (CVD). However, its underlying mechanisms remain unclear. We investigated TMAO levels across different CVD-risk patient groups, and evaluated associations between TMAO and vascular alterations (e.g., arteri...

Background Exacerbated heart failure is a condition with a high frequency of hospitalizations and mortality, especially in overweight patients. Screening and treatment for sleep apnea can be helpful in these patients. Purpose To determine the frequency and the phenotypic characteristics and of sleep apnea in patients with overweight and exacerbate...

Background The main factor responsible for atrial cardiomyopathy (ACM) is atrial fibrillation (AF). It is known that AF causes remodeling of the left atrium but its effects on the right heart chambers and mortality are not well studied. Purpose To assess the echocardiographic characteristics of patients with atrial cardiomyopathy with long-standin...

Funding Acknowledgements Type of funding sources: None. Background Left ventricular (LV) ejection fraction (LVEF) is most commonly used validated echocardiographic parameter of systolic function estimation, but left ventricular (LV) global longitudinal strain (GLS) is an early indicator of subclinical cardiac dysfunction, even when LVEF is normal....

Funding Acknowledgements Type of funding sources: None. Background Obesity and atrial fibrillation (AF) are emerging health problem, associated with significant morbidity and mortality. There is a significant relation between body mass index (BMI) on one hand and the amount of visceral fat and epicardial adipose tissue (EAT) on the other (1,2). EA...

Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is a progressive disease and can initiates and maintains in the absence of left atrial (LA) enlargement¹´². Echocardiographic parameters of LA mechanics had been proposed for best dealing with patients in AF³ . Combining different laboratory biomarkers with...

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Medical University - Sofia Background Often accompanying comorbidity in patients with acute heart failure and overweight is sleep disorders. Searching and treatment of sleep apnea will be helpful in these patients. CPAP therapy may improve the prognosis....

Unlabelled: Chest pain and dyspnoea are among the most common complaints seen in the emergency room and each symptom calls for a broad differential diagnosis. Large hiatal hernias are infrequent, but they can lead to atypical symptoms mimicking different cardiovascular, pulmonary and neoplastic diseases. We present two cases of older patients with...

Background Guidelines recommend evaluating the risk/benefit ratio of novel therapies individually in women and men, as the pathophysiology and the response to treatment may differ according to sex. Among patients with acute heart failure (AHF), a strategy of intensive vasodilation, compared with usual care, overall did provide comparable outcomes....

Background Despite the striking therapeutic progress made in the treatment of heart failure (HF), rehospitalization rate and mortality remain a major and often unpredictable problem. Previous studies have shown the prognostic value of Kansas City Cardiomyopathy Questionnaire (KCCQ), a score assessing disease-specific health-related quality of life...

Aims To investigate the impact of patiromer on serum potassium level and its ability to enable specified target doses of renin-angiotensin-aldosterone system inhibitor (RAASi) use in patients with heart failure and reduced ejection fraction (HFrEF). Methods and results A total of 1642 patients with HFrEF and current or a history of RAASi-related h...

Objective: Increased arterial stiffness is an early predictor of cardiovascular changes. However the association between arterial stiffness with LV myocardial changes is poorly understoodThe aim of this study was to examine the relationship between arterial stiffness and LV function in well - controlled hypertensive patients.Methods: A total 100 c...

Funding Acknowledgements Type of funding sources: None. INTRODUCTION Arterial stiffness is an independent risk factor in arterial hypertension, but little is known about the association between left –heart side remodeling and arterial stiffness in middle – aged hypertensive patients. AIM The aim of our study was to assess the independence between...

Background Especially in patients with acute heart failure (AHF) the NYHA classification remains of uncertain representation of patients' actual health state. Alternatively, patient's subjective well-being, in terms of health-related quality of life (HRQL), showed to have an excellent prognostic ability in out clinic patients with chronic heart fai...

Importance Inflammation promotes cardiovascular disease and anti-inflammatory treatment reduces cardiovascular events in patients with chronic coronary syndrome. Chronic kidney disease (CKD) is a risk factor for cardiovascular disease. It is unclear how inflammation mediated by interleukin 6 (IL-6) in patients with CKD is linked to cardiovascular d...

Aims We investigated the associations between obesity, cardiorenal events, and benefits of dapagliflozin in patients with type 2 diabetes mellitus (T2DM). Methods and results DECLARE–TIMI 58 randomized patients with T2DM and either atherosclerotic cardiovascular (CV) disease or multiple risk factors to dapagliflozin vs. placebo. Patients were st...

Aims We aimed to assess the long-term effect of a strategy of comprehensive vasodilation versus usual care on health-related quality of life (HRQL) among patients with acute heart failure (AHF). Methods and results Health-related quality of life was prospectively assessed by the generic 3-levelled EQ-5D and the disease-specific Kansas City Cardiom...

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Medical University - Sofia University Hospital "Tsaritsa Yoanna – ISUL” Background Often accompanying comorbidity in patients with heart failure and overweight is sleep disorders. Detection and treatment of sleep apnea will be helpful in these patients...

Objective Arterial stiffness is an independent risk factor in arterial hypertension, but little is known about the association between left atrial remodeling and arterial stiffness in middle – aged hypertensive patients. AIM To investigate the early changes in left atrial (LA) mechanical function and parameters of arterial stiffness in a populatio...

Background Ticagrelor reduces ischemic risk but increases bleeding in patients with prior myocardial infarction. Identification of patients at lower bleeding risk is important in selecting patients who are likely to derive more favorable outcomes versus risk from this strategy. Methods and Results PEGASUS‐TIMI 54 (Prevention of Cardiovascular Even...

Funding Acknowledgements Type of funding sources: None. BACKGROUND Arterial hypertension (HTN) is the most prevalent risk factor for Atrial fibrillation (AF) through structural and functional changes of the left atrium. Paroxysmal AF is mainly asymptomatic and silent forms in patients with HTN are associated with thromboembolic complications. Howe...

Aims Cardiac myosin‐binding protein C (cMyC) seems to be even more sensitive in the quantification of cardiomyocyte injury versus high‐sensitivity cardiac troponin (hs‐cTn), and may therefore have diagnostic and prognostic utility. Methods and results In a prospective multicentre diagnostic study, cMyC, hs‐cTnT, and N‐terminal pro‐B‐type natriuret...

Heart failure is often accompanied by sleep disorders. CPAP therapy has proven in the treatment of obstructive sleep apnea, but the benefits associated with comorbid patients and patients with heart failure is still under research. On the other hand, central sleep apnea is also with high frequency in these patients and more difficult to treat. The...

Background: Telemedicine is an alternative to the standard consultation with a specialist during COVID-19 pandemic. Though their benefits are not well studied, the phone consultations are a potential effective resource for providing medical and psycho-social help to patients with chronic diseases during social isolation. Aim: To assess the demograp...

Background Guidelines recommend evaluating the risk/benefit ratio of novel therapies individually in women and men, as the pathophysiology and the response to treatment may differ between women and men. Among patients with acute heart failure (AHF), a strategy of intensive vasodilation, compared with usual care, overall did provide comparable outco...

Background Non-invasive measurements of 24 h ambulatory central aortic systolic pressure (24hCASP) is now feasible method than single measurement of CASP. There is growing interest in CASP as cardiovascular risk marker beyond conventional brachial blood pressure (BP). Pulse wave velocity estimates arterial stiffness, whereas CASP is representative...

Background Left atrial volume index (LAVi) has been established as a surrogate marker for chronically elevated left ventricular (LV) filling pressure. Moreover it is a powerful predictor of atrial fibrillation (AF) in different pathologies. However, there is limited data for additional and sensitive echocardiographic predictors of AF in patients wi...

Background: In ENSURE-AF study, edoxaban had similar efficacy and safety profile versus enoxaparin-warfarin (enox-warf) in patients undergoing electrical cardioversion of non-valvular atrial fibrillation. Objectives: To evaluate the efficacy and safety of edoxaban versus enox-warf in patients who were vitamin K antagonists (VKA) naïve or experie...

Cardiomyopathy is a frequent complication of pheochromocytoma and echocardiography is the most accessible method for its evaluation. The objective of this study was to assess the clinical significance of classical and novel echocardiographic parameters of cardiac function in 24 patients with pheochromocytomas (PPGL) compared to 24 subjects with ess...

Topic(s): Risk Factors and Prevention-Cardiovascular Risk Assessment Citation: Background: The 24hour central aortic pressure is an early predictor of cardiovascular complications in hypertension. However, the association between arterial stiffness and left ventricular dysfunction is poorly understood.

Background Left ventricular (LV) global longitudinal strain (GLS) is a more sensitive parameter than ejection fraction in the assessment of LV function. It has been established as a predictor of cardiac death and adverse events. In patients with dilated cardiomyopathy (DCM) LV deformation and twist mechanics are reduced in varying degrees. Purpose...

BACKGROUND Vascular stiffness and left atrial volume index (LAVI) are predictors of cardiovascular complications in hypertensive patients. The correlation of left atrium (LA) with left ventricle (LV) – arterial functional changes has not been well established. PURPOSE To investigate the relationship between LA remodeling and ventriculoarterial fun...

Introduction: In dilated cardiomyopathy (DCM) left ventricular (LV) strain and twist are significantly decreased. However, the rate of attenuation has not been investigated well in patients with varying degrees of systolic dysfunction. Aim: The present study aimed to investigate the relationship between LV deformational and rotational mechanics...

Importance Short-term infusions of single vasodilators, usually given in a fixed dose, have not improved outcomes in patients with acute heart failure (AHF). Objective To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation using individualized up-titrated doses of established vasodilators in patients with A...

Topic(s): Risk Factors and Prevention-Cardiovascular Risk Assessment Citation: BACKGROUND: The concept of "ventriculoarterial coupling" could be a key determinant for the prediction of cardiovascular events. The interaction between left atrium (LA) and ventriculoarterial coupling for evaluation of functional abnormalities remains unclear.

Background: Serelaxin is a recombinant form of human relaxin-2, a vasodilator hormone that contributes to cardiovascular and renal adaptations during pregnancy. Previous studies have suggested that treatment with serelaxin may result in relief of symptoms and in better outcomes in patients with acute heart failure. Methods: In this multicenter,...

https://pdfs.journals.lww.com/jhypertension/2019/07001/ASSOCIATION_BETWEEN_CENTRAL_AORTIC_PRESSURE_AND.884.pdf?token=method|ExpireAbsolute;source|Journals;ttl|1599214647093;payload|mY8D3u1TCCsNvP5E421JYK6N6XICDamxByyYpaNzk7FKjTaa1Yz22MivkHZqjGP4kdS2v0J76WGAnHACH69s21Csk0OpQi3YbjEMdSoz2UhVybFqQxA7lKwSUlA502zQZr96TQRwhVlocEp/sJ586aVbcBFlltKNKo+tbuMfL...

Background: Relative hypochromia of erythrocytes defined as a reduced mean corpuscular hemoglobin concentration (MCHC) is a surrogate of iron deficiency. We aimed to evaluate the prevalence and prognostic impact of relative hypochromia in acute heart failure (AHF). Methods: We prospectively characterized 1574 patients presenting with an adjudica...

Background: The MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF) score was developed to predict 30-day mortality in patients presenting with acute heart failure (AHF) to emergency departments (EDs) in Spain. Whether it performs well in other countries is unknown. Objective: To external...

Galectin 3, reccurent Atrial fibrillation

Table S1. Baseline Characteristics by Recurrent Myocardial Infarction Figure S1. Cumulative incidence of myocardial infarction subtypes occurring in patients randomized to placebo (on aspirin monotherapy) during follow‐up. Figure S2. Ticagrelor and fatal myocardial infarction, sudden cardiac death, and the composite of both.

Background Ticagrelor reduced cardiovascular death, myocardial infarction (MI), or stroke in patients with prior MI in PEGASUS‐TIMI 54 (Prevention of Cardiovascular Events [eg, Death From Heart or Vascular Disease, Heart Attack, or Stroke] in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin). MI can o...

Aim: The aim was to investigate twist alterations depending on the degree of functional mitral regurgitation (MR) by speckle-tracking echocardiography. Methods: Sixty-three patients with symptomatic dilated cardiomyopathy (DCM) were included. Patients were divided according to MR vena contracta width (VCW): group 1 with VCW <7 mm (mild/moderate...

Background: Patients with prior myocardial infarction (MI) and multivessel coronary disease (MVD) are at high risk for recurrent coronary events. Objectives: The authors investigated the efficacy and safety of ticagrelor versus placebo in patients with MVD in the PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart A...

In the EdoxabaN versus warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation (ENSURE-AF) study, edoxaban was compared with enoxaparin-warfarin in patients who underwent electrical cardioversion of nonvalvular atrial fibrillation, showing comparable low rates of bleeding and thromboembolism. The present study is an ancillary analysis...

Background: Ticagrelor reduces ischemic risk in patients with prior myocardial infarction (MI). It remains unclear whether ischemic risk and the benefits of prolonged P2Y12 inhibition in this population remain consistent over time. Objectives: The study sought to investigate the pattern of ischemic risk over time and whether the efficacy and saf...

Familial hypercholesterolemia (FH) is a genetic disorder with well-known genetic transmission and clinical course. Despite great recent progress, FH is still underestimated, under-diagnosed and thus undertreated. Furthermore it represents a significant healthcare challenge as a common risk factor for the premature development of coronary heart dise...

Introduction: Despite great recent progress, familial hypercholesterolemia (FH) is still underestimated, under-diagnosed and thus undertreated worldwide. We have very little information on exact prevalence of patients with FH in the Central, Eastern and Southern Europe (CESE) region. The aim of the study was to describe the epidemiological situati...

Background: Impaired contractility is a feature of heart failure with reduced ejection fraction. We assessed the pharmacokinetics and effects on cardiac function and structure of the cardiac myosin activator, omecamtiv mecarbil. Methods: In this randomised, double-blind study, done at 87 sites in 13 countries, we recruited patients with stable,...

BACACKGROUND:Edoxaban, an oral factor Xa inhibitor, is non-inferior for prevention of stroke and systemic embolism in patients with atrial fibrillation and is associated with less bleeding than well controlled warfarin therapy. Few safety data about edoxaban in patients undergoing electrical cardioversion are available. METHODS: We did a multicentr...

Background: Long-term dual antiplatelet therapy with aspirin plus ticagrelor, a direct-acting reversibly-binding P2Y12 receptor antagonist, was recently shown in the PEGASUS-TIMI 54 trial (NCT01225562) to be superior to aspirin alone in preventing major adverse cardiovascular events in patients with a prior MI. Whereas prior analyses focused on tim...

Objectives: Ticagrelor reduced the risk of CV death, MI or stroke in stable patients with prior MI in PEGASUS-TIMI 54. We investigated the consistency of ticagrelor’s efficacy and safety over time and quantified the magnitude of benefit in patients who tolerated ticagrelor for the first year, analogous to the clinical situation of extending therapy...

Aims: We evaluated the relationship of renal function and ischaemic and bleeding risk as well as the efficacy and safety of ticagrelor in stable patients with prior myocardial infarction (MI). Methods and results: Patients with a history of MI 1-3 years prior from PEGASUS-TIMI 54 were stratified based on estimated glomerular filtration rate (eGF...

Statins are one of the most commonly prescribed drugs in clinical practice. They are usually well tolerated and effectively prevent cardiovascular events. Most adverse effects associated with statin therapy are muscle-related. The recent statement of the European Atherosclerosis Society (EAS) has focused on statin-associated muscle symptoms (SAMS),...

Statins are one of the most commonly prescribed drugs in clinical practice. They are usually well tolerated and effectively prevent cardiovascular events. Most adverse effects associated with statin therapy are muscle-related. The recent statement of the European Atherosclerosis Society (EAS) has focused on statin associated muscle symptoms (SAMS),...

-Clinical trials in heart failure have focused on the improvement in symptoms or decreases in the risk of death and other cardiovascular events. Little is known about the effect of drugs on the risk of clinical deterioration in surviving patients. -We compared the angiotensin-neprilysin inhibitor LCZ696 (400 mg daily) with the angiotensinconverting...

Post-marketing observational studies are valuable for establishing the real-world effectiveness of treatment regimens in routine clinical practice as they typically monitor a diverse population of patients over many months. This article reviews recent observational studies of angiotensin receptor blockers (ARBs) for the management of hypertension:...

During the past 10 years, the health of people in Eastern Europe and the former Soviet Union has undergone changes very different from the health patterns seen in their Western counterparts. Mortality from cardiovascular disease has been decreasing continuously in the USA and many Western European countries, but it has increased or remained unchang...

AIMS: Although the focus of therapeutic intervention has been on neurohormonal pathways thought to be harmful in heart failure (HF), such as the renin-angiotensin-aldosterone system (RAAS), potentially beneficial counter-regulatory systems are also active in HF. These promote vasodilatation and natriuresis, inhibit abnormal growth, suppress the RAA...

Background. High blood pressure is a substantial risk factor for cardiovascular disease. Design & Methods. The Physicians' Observational Work on patient Education according to their vascular Risk (POWER) survey was an open-label investigation of eprosartan-based therapy (EBT) for control of high blood pressure in primary care centers in 16 countrie...

Imbalance of activation and inhibition of matrix metalloproteinases (MMPs) lead to an increase in their activity and the occurrence of pathological changes in the vascular wall. The purpose of this paper is to determine the role of MMP-2 and MMP-9 in vascular and ventricular remodelling in patients with heart failure with preserved ejection fractio...

Implementation of new biochemical markers of acute coronary syndrome (ACS) could be helpful in early diagnosis, monitoring and risk stratification in addition to standard risk models. The purpose of our study is to determine the role of high sensitivity C-reactive protein (hsCRP), soluble CD40 Ligand (sCD40L) and endothelial dysfunction in patients...

Background: Heart failure /HF/ is usually associated with reduced systolic function. Elevated plasma concentrations of NTproBNP and heart rate variability /HRV/ are predictive of worse outcome in HF patients but there are few data about its predictive value in patients with HF and preserved systolic function. Purpose and methods: The aim of this st...

Estimation of total cardiovascular risk is useful for developing preventive strategies for individual patients. The POWER (Physicians' Observational Work on Patient Education According to their Vascular Risk) survey, a 6-month, open-label, multinational, post-marketing observational evaluation of eprosartan, an angiotensin II receptor blocker, was...

The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 m...