Aspirin Therapy for Heart Disease Prevention: Who Really Needs It?

For decades, taking a daily low-dose aspirin was common advice for anyone worried about heart disease. If your parent had a heart attack, your doctor probably told you to start a baby aspirin. But that advice has changed-dramatically. As of 2025, most healthy adults should not take aspirin to prevent their first heart attack or stroke. The risks now often outweigh the benefits. This isn’t just a minor tweak in guidelines. It’s a full reversal based on over a decade of new evidence from large, high-quality studies.

Why Aspirin Was Once Recommended

Aspirin works by blocking platelets-tiny blood cells that clump together to form clots. In people who already have narrowed arteries from plaque buildup, a clot can trigger a heart attack or stroke. Aspirin’s ability to thin the blood made it seem like a perfect shield for those at risk. For people who’d already had a heart attack, stroke, or stent placement, aspirin remains one of the most effective, low-cost tools to prevent another event. That’s called secondary prevention, and it still works.

But using aspirin before any heart problem occurs-that’s primary prevention. And that’s where things went wrong. For years, doctors assumed that if aspirin helped people with existing heart disease, it would help healthy people too. But the science didn’t support that. Three major studies published in 2018 (ASPREE, ASCEND, ARRIVE) showed that for most healthy adults, aspirin didn’t reduce heart attacks or strokes enough to justify the bleeding risks.

Who Shouldn’t Take Aspirin for Prevention

If you’re 60 or older and have never had a heart attack, stroke, or stent, do not start aspirin. The U.S. Preventive Services Task Force (USPSTF) updated its guidelines in 2022 to say clearly: avoid initiating aspirin for primary prevention in adults 60 and older. Why? Because the risk of serious bleeding-especially in the stomach or brain-goes up sharply with age. By 65, the chance of a major bleed from aspirin is higher than the chance of preventing a first heart event.

Even if you’re under 60, you shouldn’t take aspirin unless you’re at high risk. Many people assume that having a family history of heart disease means they need aspirin. That’s not enough. Your dad might’ve had a heart attack at 58, but if you don’t smoke, your blood pressure is normal, your cholesterol is under control, and you don’t have diabetes, your actual risk is low. Aspirin won’t help you-and it might hurt you.

Who Might Still Benefit

There’s a small group of people between 40 and 59 who might still benefit from aspirin. But only if they meet all of these conditions:

• They have a 10% or higher risk of having a heart attack or stroke in the next 10 years
• They have no increased risk of bleeding
• They’re willing to take it daily for at least 10 years
• They’ve talked it through with their doctor

To calculate your 10-year risk, your doctor uses a tool called the ACC/AHA Pooled Cohort Equation. It asks for your age, sex, race, total cholesterol, HDL (good cholesterol), systolic blood pressure, whether you have diabetes, and if you smoke. If your score is below 7.5%, aspirin is not recommended. At 10% or higher, it becomes a possible option-but still not automatic.

One group where aspirin is still often considered: people with type 2 diabetes who are over 40 and have at least one other risk factor, like high blood pressure or smoking. The American Diabetes Association still says aspirin might help here, because diabetes is such a strong risk factor for heart disease. But even then, the decision isn’t one-size-fits-all.

What Counts as High Bleeding Risk?

Before even thinking about aspirin, you need to check your bleeding risk. If you’ve had:

• A stomach ulcer or GI bleed in the past
• Regular use of NSAIDs like ibuprofen or naproxen
• Heavy alcohol use (more than 3 drinks a day)
• Blood thinners like warfarin or apixaban
• Uncontrolled high blood pressure
• Age over 65

…then aspirin is likely dangerous for you. Doctors use a tool called HAS-BLED to score this. A score of 3 or higher means high bleeding risk-and aspirin should be avoided.

One study found that for every 100 people like you taking aspirin for 10 years, about 1 might avoid a heart attack-but 2 might have a serious bleed that needs hospitalization or a blood transfusion. That’s not a good trade-off.

Why So Many People Still Take It

Despite the guidelines, an estimated 29 million Americans without heart disease still take daily aspirin. Why? Because habits die hard. Many people were told years ago to take it, and never re-evaluated. Others rely on family history as their main reason: “My dad had a heart attack at 55, so I’m taking it.” But genetics alone don’t justify aspirin. You can’t control your genes, but you can control your blood pressure, cholesterol, weight, and smoking habits.

Another reason: misinformation. Online forums, social media, and even well-meaning friends tell people aspirin is “good for the heart.” But the science doesn’t back that up for healthy people. In fact, a 2022 study found that 58% of adults aged 60-75 in the U.S. were still taking aspirin for prevention, even though most of them didn’t meet the high-risk criteria.

What to Do Instead

If you’re not taking aspirin for prevention, what should you focus on? These four things are far more effective and safer:

1. Take a statin if your cholesterol is high or you have diabetes. Statins reduce heart attack risk by 25-37%. Aspirin? Only 10-15%.
2. Control your blood pressure. Keeping it under 120/80 cuts heart disease risk more than any pill.
3. Don’t smoke. Quitting cuts your heart attack risk in half within a year.
4. Move daily. Just 30 minutes of brisk walking five days a week reduces heart disease risk by 30%.

These lifestyle changes don’t just lower your risk-they improve your energy, sleep, mood, and longevity. Aspirin does none of that. It only lowers clotting risk, and even then, only for a small group.

What If You’re Already Taking It?

If you’ve been taking low-dose aspirin (75-100 mg) daily for years and you’re over 60 with no history of heart disease, don’t stop suddenly. Talk to your doctor. Stopping abruptly can increase short-term clot risk. But if you’re over 70, have no heart history, and are taking aspirin just because “it’s good for you,” you’re probably better off stopping. Your doctor can help you taper off safely.

Some people worry about stopping because they feel like they’re giving up protection. But think of it this way: you’re not losing protection-you’re removing a risk that never should’ve been there in the first place.

Aspirin vs. Other Options

Aspirin is cheap-about $4 to $6 for a three-month supply. But it’s not the only option. Newer antiplatelet drugs like clopidogrel are more targeted and cause less stomach bleeding. But they’re also much more expensive and still not recommended for primary prevention. Statins, on the other hand, are now the cornerstone of heart disease prevention. They don’t just lower cholesterol-they stabilize plaque, reduce inflammation, and lower the risk of heart attack by more than aspirin ever could.

For most people, aspirin is no longer the right tool. Statins, blood pressure control, and lifestyle changes are.

What’s Next for Aspirin Therapy?

Research is still ongoing. The ASPREE-2 trial is looking at whether stopping aspirin after age 70 affects dementia or physical decline. The American Heart Association plans to update its guidelines in 2024, possibly using coronary calcium scans to better identify who might still benefit. These scans can show hidden plaque buildup-even in people who feel fine.

But the direction is clear: aspirin’s role in heart disease prevention is shrinking. It’s no longer a general health habit. It’s a targeted medical decision, only for a small group of high-risk adults under 60 who have no bleeding risks-and even then, only after a careful conversation with a doctor.

For the vast majority of people, the best way to protect your heart isn’t a pill you swallow every morning. It’s walking, eating well, managing stress, getting your numbers checked, and working with your doctor-not following outdated advice.