Cardiac Diseases See  Heart Diseases Prevention 

Secondary prevention 

• Aspirin provides benefit in nearly all groups  of patients  with clinical manifestations  of coronary heart disease. This includes patients with evolving acute myocardial infarction  or after recovery  from myocardial infarction, with unstable  or stable angina,  and those who undergo coronary artery bypass grafting  or coronary angioplasty. 
• Aspirin provides benefit  in patients with peripheral arterial disease.  This includes patients with acute  or previous history  of ischaemic stroke  or transient ischaemic attack, those  with lower limb arterial insufficiency,  and those who undergo grafting or angioplasty of peripheral arterial vessels. 

• People without symptoms but  at increased risk of a coronary heart disease event (> 1% annual risk) may reduce  this risk by taking low-dose aspirin. However,  the decision  to take aspirin requires detailed consideration of individual cardiovascular  risk and the potential benefit versus harm  of treatment, particularly bleeding. 
• Aspirin should only be used  to prevent  a cardiovascular event  in association  with an overall program of lifestyle measures including  healthy eating, cessation of smoking, control of  blood pressure and regular  physical activity. 

• Prevention benefits  of aspirin  in heart disease  can be achieved  with doses  as low as 75–150 mg daily. 
• Unwanted effects  of aspirin include stomach upsets, activation  of peptic ulcers, an increased tendency  to bruising, allergic reactions  and increased risk  of major gastrointestinal  and other bleeding, including intracranial haemorrhage. In general,  the risk of bleeding  increases with increasing dose  of aspirin  and when it is used in combination  with non-steroidal anti-inflammatory drugs  or oral anticoagulants.