Daily Aspirin: Should You Take It? What the Latest Research Says
Many people have heard that taking a low-dose (daily) aspirin can help prevent heart attacks or strokes. For decades, the idea of “an aspirin a day” has been widely accepted. But in recent years, new research and newer guidelines have challenged this belief. Whether you should take daily aspirin now depends on many factors: your age, medical history, bleeding risk, and more. This article walks you through what the latest evidence shows, what benefits and risks exist, and how to make a decision with your doctor.
How Aspirin Works in Your Body
Aspirin (acetylsalicylic acid) is a medicine you probably know for pain relief, fever, or inflammation. But at low doses, one of its key effects is thinning the blood.
- It reduces the stickiness of platelets (cells that help blood clot).
- By doing this, aspirin can lower the chance of small blood clots forming in arteries, which could block blood flow and cause a heart attack or stroke.
- This “antiplatelet” effect is why aspirin has long been used in people with established heart disease or after a heart attack or stroke (this is called secondary prevention).
However, the same thinning effect also increases the risk of bleeding—especially in the stomach or brain. So, for people who haven’t had a heart attack or stroke (called primary prevention), the tradeoff between benefit and harm is more delicate.
What the Latest Research and Guidelines Say
Shifting guidance in recent years
In the past, many guidelines were more liberal in recommending low-dose aspirin for people at risk of heart disease. But more recent large trials and reviews have changed that picture.
- In 2022, the U.S. Preventive Services Task Force (USPSTF) updated its recommendation: for people age 60 or older, they now advise against starting daily low-dose aspirin for primary prevention (i.e. preventing the first heart attack or stroke).
- For people aged 40 to 59 who have a 10-year cardiovascular risk of at least 10%, they say the decision to use aspirin “should be an individual one,” considering bleeding risks and personal preferences.
- The new guidelines reflect that the benefit of aspirin in preventing nonfatal heart events is modest, and that aspirin does not clearly reduce death rates from cardiovascular disease or all-cause mortality in most people without known disease.
- Also, many people continue to take aspirin despite the updated guidelines, often without discussion with their doctors.
In short: the role of daily aspirin in healthy people is now much more limited than it used to be.
What benefits remain — and what the risks are
Potential benefits (in select people):
- Lower risk of nonfatal heart attacks (myocardial infarction). In pooled trials, aspirin reduced nonfatal MI by about 10–15%.
- Slight reduction in nonfatal strokes in some studies.
- In people with existing cardiovascular disease (those who already had a heart attack or stroke), aspirin still has a clear benefit in preventing further events (secondary prevention).
Who Might Consider a Daily Aspirin — and Who Should Avoid It
Who might benefit
A daily low-dose aspirin might be considered under these conditions:
- You are between ages 40 and 59, and your estimated 10-year cardiovascular disease (CVD) risk is at least 10%.
- You have no higher-than-usual bleeding risk (no history of ulcers, bleeding, stroke, or other bleeding conditions).
- You are willing to accept the bleeding risk in exchange for a small chance of reducing heart attack or stroke.
- You have already had a cardiovascular event (heart attack, stroke, stent, bypass) — then aspirin is often standard therapy (secondary prevention).
Even when all these conditions are present, the decision is not automatic; it should be made jointly with your doctor.
Who should not take daily aspirin
- People 60 years or older who have never had a heart attack or stroke — the new guidelines generally advise against starting aspirin.
- Those with high risk of bleeding, such as history of gastrointestinal ulcers, bleeding disorders, bleeding in the brain, or on medications that increase bleeding (like certain blood thinners or anti-inflammatory drugs).
- People with uncontrolled high blood pressure or other conditions that elevate bleeding risk.
- People for whom life expectancy is limited or frail elders in whom bleeding complications would have severe consequences.
- Individuals with no signs of cardiovascular disease and relatively low risk — the absolute benefit of aspirin is very small in this group.
How to Decide: A Practical Approach
Here is a simple step-by-step approach to decide whether daily aspirin might (or might not) be right for you:
| Step | What to Do | Why It Matters |
|---|---|---|
| 1 | Talk with your doctor | You need a medical evaluation of your heart risk and bleeding risk |
| 2 | Estimate your 10-year CVD risk | Many risk calculators consider age, cholesterol, blood pressure, smoking, diabetes, etc. |
| 3 | Assess bleeding risk | Ask about ulcers, past bleeding, medications, liver disease, etc. |
| 4 | Weigh benefits vs. harms | For moderate risk, the potential reduction in heart events might just balance bleeding risk |
| 5 | Decide together | All things considered, your values (how much bleeding risk you accept) matter |
| 6 | Reassess over time | Risk changes with age, new health conditions, or medications |
If you and your doctor decide to proceed, the typical dose used in trials is low-dose aspirin (often 75-100 mg daily). Higher doses are not needed for heart protection and come with greater bleeding risk.
If you are already taking aspirin and fall into a group where newer guidelines discourage its use, your doctor may discuss whether to stop or adjust it.
Key Takeaways
- Aspirin has long been known to lower clotting and reduce some kinds of heart events.
- Newer research and guidelines have narrowed the use of daily aspirin for primary prevention (in people without previous heart disease).
- For people age 60 or older, experts now generally recommend not starting daily aspirin if you have no history of cardiovascular disease.
- For people age 40–59 with elevated cardiovascular risk (≥10%) and low bleeding risk, the decision to use aspirin should be individualized.
- Aspirin is still clearly beneficial for secondary prevention — for those who have already had a heart attack, stroke, or stent.
- Always involve your doctor in the decision, weighing your personal risks and preferences.
FAQ (Frequently Asked Questions)
1. Is aspirin safe to take every day for everybody?
No. Daily aspirin is not safe for everyone. While it can reduce clotting risk, it also increases bleeding risk, especially in the stomach or brain. For many healthy people, the harm can outweigh the benefit.
2. I’m 65 and healthy. Should I start daily aspirin?
Probably not, unless you have other risk factors for heart disease and very low risk of bleeding. Newer guidelines generally advise against starting aspirin in people 60 or older who have never had heart disease.
3. I’ve had a heart attack before — should I keep taking aspirin?
Yes, in most cases aspirin is part of standard therapy after a heart attack or stroke (secondary prevention). But you should always follow your cardiologist’s advice about dose, duration, and other medicines.
4. How do I know if my bleeding risk is too high?
Ask your doctor. Risks include past ulcers or bleeding, use of blood-thinning drugs, liver disease, kidney disease, past stroke with bleeding, older age, etc.
5. If I decide against aspirin now, can I change my mind later?
Yes. Your health risks can change with age, new diseases, or medications. You and your doctor should revisit the decision periodically.
