For years, millions of healthy adults took a daily low-dose aspirin believing it would protect them from a heart attack or stroke. It seemed simple: one pill, one less chance of something serious happening. But that thinking has changed-dramatically. Today, the science is clear: for most people without existing heart disease, daily aspirin does more harm than good. The question isnât whether aspirin works-itâs who should skip it entirely.
Why the Rules Changed
Back in the 1990s, studies like the Physiciansâ Health Study showed aspirin could reduce first heart attacks in men. That led to widespread recommendations. By 2016, about 40 million Americans were taking daily aspirin for prevention. But as more data came in, the picture got messier. The benefits were smaller than thought. The risks? Bigger. The U.S. Preventive Services Task Force (USPSTF) flipped its stance in 2022. Instead of recommending aspirin for adults 50-59 with moderate heart disease risk, they now say: donât start it if youâre 60 or older. Why? Because for every 1,000 people over 60 taking aspirin daily for 10 years, about 1.6 will suffer a major bleed-like a stomach ulcer or brain hemorrhage-while only 0.9 will avoid a heart attack. Thatâs not a win. Itâs a net loss. The American Heart Association and American College of Cardiology agree. Routine aspirin for primary prevention is no longer recommended. The European Society of Cardiology doesnât recommend it at all, at any age. The shift isnât about new drugs-itâs about better data. We now know who benefits and who doesnât. And for most, the answer is: you donât.Who Definitely Should Skip Aspirin
If youâre 60 or older and have never had a heart attack, stroke, stent, or bypass, you should not start daily aspirin. Thatâs the clearest rule. The bleeding risk rises sharply with age. By 70, your stomach lining is more fragile. Your blood vessels are more likely to rupture. Even a small bleed can be life-threatening. You should also skip it if you have:- A history of stomach ulcers or bleeding (about 4% of U.S. adults have this)
- Current use of blood thinners like warfarin, apixaban, or rivaroxaban
- Regular use of NSAIDs like ibuprofen or naproxen (common for arthritis pain)
- Kidney disease or liver disease
- A history of bleeding in the brain
- Uncontrolled high blood pressure
What About People Under 60?
For people aged 40-59, the answer isnât as simple. If your 10-year risk of heart disease is 10% or higher-calculated using tools like the ACC/AHA Pooled Cohort Equations-you might consider aspirin. But only after a detailed conversation with your doctor. That 10% threshold isnât magic. Itâs a starting point. Someone with high cholesterol, diabetes, and a family history of early heart disease might hit that number. But if they also have a history of gastritis or take daily ibuprofen, the scales tip the other way. The key is balancing risk. For every 265 people in this group who take aspirin for 10 years, one heart attack might be prevented. But one major bleed might happen too. Thatâs why guidelines say: individual decision. Not automatic. Not routine. Only after youâve weighed your personal risks and preferences.
Diabetes and Aspirin: A Special Case
People with diabetes were once thought to be clear candidates for daily aspirin. After all, they have higher heart disease risk. But newer data shows itâs not that simple. The 2025 AHA/ACC diabetes guidelines say aspirin may be considered for adults with diabetes aged 40-70 only if their 10-year ASCVD risk is 15% or higher and they have no bleeding risk factors. Even then, itâs a âmight considerâ recommendation-not a strong one. And hereâs the twist: not all diabetics benefit. A March 2024 meta-analysis found aspirin reduced heart events by 19% in diabetics with high Lp(a)-a genetic cholesterol particle linked to plaque buildup. But for those with normal Lp(a)? No benefit at all. That means blanket recommendations for diabetics are outdated. Testing for Lp(a) or coronary calcium scores might be needed to decide.Why So Much Confusion Among Patients?
If youâve been taking aspirin for years, youâre not alone in feeling unsure. A 2023 Mayo Clinic survey found 41% of adults 60+ kept taking aspirin even after new guidelines came out. Why? Fear. âIâve been on it since my 50s,â one patient told a doctor. âWhat if I stop and have a heart attack tomorrow?â That fear is real. But so is the data. A 2023 study in JAMA Internal Medicine showed that patients who stopped aspirin after age 60 didnât see a spike in heart attacks-unless they had very high coronary calcium scores (above 300). For most, stopping was safe. Another issue? Doctors disagree. A 2023 JAMA Internal Medicine study found 57% of patients reported getting conflicting advice. Primary care doctors are more likely to stop aspirin. Cardiologists are more likely to keep it, especially if the patient has a high calcium score. Thatâs not inconsistency-itâs complexity. But it leaves patients confused.
What You Should Do Instead
If youâre healthy and thinking about aspirin, skip the pill. Focus on what actually moves the needle:- Control your blood pressure
- Lower your LDL cholesterol with diet, exercise, or statins if needed
- Donât smoke
- Manage diabetes if you have it
- Exercise at least 150 minutes a week
- Get a coronary calcium scan if youâre 40-70 and have risk factors
What If Youâre Already Taking It?
If youâre on daily aspirin and have no heart disease, donât stop cold turkey. Talk to your doctor. Stopping suddenly can cause rebound clotting in rare cases. But if youâre over 60, have no history of heart issues, and have any bleeding risk factors, stopping is likely the right move. Your doctor should use a shared decision-making approach. That means discussing:- Your 10-year heart disease risk (calculated using Pooled Cohort Equations)
- Your bleeding risk (HAS-BLED score helps here)
- Your personal preferences
- Your other medications
The Bottom Line
Aspirin isnât a magic shield. Itâs a tool-with side effects. For most healthy people, itâs the wrong tool. The era of âjust take one a dayâ is over. The new standard is: donât start unless youâre in a very specific, high-risk group with low bleeding risk. If youâre under 60 and healthy? Focus on lifestyle. If youâre over 60? Donât start. If youâre already taking it? Talk to your doctor. Donât guess. Donât fear. Let the data guide you.Should I take aspirin every day to prevent a heart attack?
For most people without heart disease, no. Daily aspirin is no longer recommended for primary prevention in adults 60 and older. For those 40-59 with high heart disease risk and low bleeding risk, it might be considered-but only after a detailed discussion with your doctor. The risks of bleeding often outweigh the small potential benefits.
Is it safe to stop taking aspirin if Iâve been on it for years?
Yes, for most people over 60 without heart disease, stopping is safe. Thereâs no evidence that stopping increases heart attack risk in this group. However, donât stop abruptly without talking to your doctor, especially if youâve been on it for more than a few years. They may recommend tapering or monitoring.
What if I have diabetes? Should I still take aspirin?
Maybe-but only if your 10-year heart disease risk is 15% or higher and you have no bleeding risk factors. Even then, itâs not a strong recommendation. New data shows aspirin only helps diabetics with high Lp(a) levels or very high coronary calcium scores. For most diabetics, lifestyle changes and statins are more effective and safer.
How do I know my 10-year heart disease risk?
Your doctor can calculate it using the ACC/AHA Pooled Cohort Equations. Youâll need your age, sex, race, cholesterol levels, blood pressure, diabetes status, and smoking history. Many clinics use online calculators or EHR tools to do this in under a minute. You can also check the American Heart Associationâs free online risk tool.
Are there tests that can help decide if aspirin is right for me?
Yes. A coronary calcium scan (CAC) shows how much plaque is in your arteries. A score over 100 suggests higher risk, and over 300 means youâre in the high-risk group where aspirin might still help. Testing for Lp(a), a genetic cholesterol marker, can also help. If your Lp(a) is above 50 mg/dL, aspirin may offer more benefit. These tests arenât routine-but theyâre valuable if youâre in the gray zone.
What are the biggest risks of daily aspirin?
The biggest risks are major bleeding events: gastrointestinal bleeding (stomach ulcers), intracranial hemorrhage (bleeding in the brain), and bleeding in other organs. Aspirin increases the risk of major gastrointestinal bleeding by 43% and intracranial bleeding by 38%. These risks rise sharply after age 60 and are worse if youâre on other blood thinners or NSAIDs.
Can I use baby aspirin instead of regular aspirin?
Baby aspirin (81 mg) is the standard low-dose form used for prevention. Higher doses donât offer more protection but increase bleeding risk. So if aspirin is recommended, 75-100 mg daily is the right dose. But again-only if your doctor says so. The dose doesnât change the risk-benefit balance.
Is aspirin still useful for anyone?
Yes-for people who already have heart disease, a stent, or a history of stroke. Thatâs called secondary prevention, and aspirin is still strongly recommended. But for people without any prior heart issues, the role of aspirin has shrunk to a very narrow group. Donât assume it helps you just because it helped someone else.
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