For years, millions of Americans took a daily low-dose aspirin to prevent their first heart attack or stroke. It was simple, cheap, and seemed like a smart move-especially if you were over 50 or had high blood pressure. But the science has changed. Aspirin is no longer a one-size-fits-all heart shield. In fact, for many people, taking it daily now does more harm than good.
Why the Rules Changed
Back in the 1980s and 90s, big studies showed aspirin could lower the risk of a first heart attack. That led to widespread advice: if you’re over 40, pop a baby aspirin. By 2016, nearly 1 in 4 adults in the U.S. were doing it. But newer, larger studies revealed a hidden cost: bleeding. The U.S. Preventive Services Task Force (USPSTF) updated its guidelines in 2022 after reviewing data from over 100,000 people. They found that for adults 60 and older, the risk of serious bleeding-like stomach ulcers or brain bleeds-outweighed any small benefit in preventing heart attacks. For people under 60 with high heart disease risk, the decision isn’t black and white. But for most others, the answer is clear: don’t start.Who Should Absolutely Skip Daily Aspirin
If you fall into any of these groups, you should not take daily aspirin for heart protection-even if your doctor used to recommend it.- Adults 60 and older without known heart disease: The risk of major bleeding increases sharply with age. For every 1,000 people over 60 taking aspirin daily for 10 years, about 1.6 will have a serious bleed. Meanwhile, only about 0.9 will avoid a heart attack. That’s a net loss.
- People with a history of stomach ulcers or GI bleeding: Aspirin irritates the stomach lining. About 4% of U.S. adults have had a peptic ulcer. For them, aspirin can trigger a life-threatening bleed.
- Those taking blood thinners like warfarin, apixaban, or rivaroxaban: Combining aspirin with these drugs multiplies bleeding risk. Nearly 1 in 5 adults over 65 take at least one of these medications.
- People who regularly use ibuprofen or naproxen: NSAIDs like Advil or Aleve also damage the stomach lining. Mixing them with aspirin is like pouring gasoline on a fire.
- Anyone with uncontrolled high blood pressure: High BP increases the chance of brain bleeds. Aspirin makes that risk worse.
What About People With High Cholesterol or Diabetes?
It’s tempting to think that if you have risk factors like high cholesterol, diabetes, or obesity, you need aspirin more. But that’s not always true. The American Heart Association and American College of Cardiology say aspirin might be considered for adults with diabetes aged 40 to 70-only if they have a 10-year heart disease risk of 15% or higher and no bleeding risk. That’s a narrow window. Many people with diabetes still don’t qualify. Even then, it’s not automatic. A 2024 study in Diabetes Care found aspirin only helped diabetic patients with a specific genetic marker called Lp(a) above 50 mg/dL. For the rest, it did nothing. That’s why doctors now use tools like coronary calcium scans (CAC) to see if plaque has actually built up in the arteries. A CAC score over 100 means real, measurable risk. For those people, aspirin might still make sense.
Why Your Doctor Might Still Recommend It
You might hear conflicting advice. Some cardiologists still prescribe aspirin for people they believe are at high risk. Why? Because guidelines are general. Real people are complex. A 58-year-old with a CAC score of 350, normal blood pressure, no stomach issues, and no other meds might still benefit from aspirin. Their risk of a heart attack is high enough that the bleeding risk is worth balancing. But this decision shouldn’t be made in 5 minutes during a routine checkup. The problem? Most primary care visits are 10 to 15 minutes long. Calculating 10-year heart disease risk using the Pooled Cohort Equations takes about 7 minutes. Few doctors have time-or training-to do it right. That’s why many just keep prescribing aspirin out of habit.The Real Cost of Taking Aspirin
Aspirin costs less than $10 a year. But the real cost isn’t in the bottle. A major gastrointestinal bleed can cost Medicare over $1,200 to treat. A brain hemorrhage? Often more than $20,000. And that’s just the medical bill. Many people need long-term rehab, home care, or nursing home placement after a bleed. That’s why hospitals like Kaiser Permanente added automated alerts in their electronic systems to flag patients getting aspirin without proper justification. Within a year, inappropriate prescriptions dropped by 67%. The FDA now requires aspirin labels to say: “Do not use for primary prevention of heart attack or stroke in adults 60+.” That’s a big deal. It means the government now officially recognizes the harm.What to Do Instead
If you’re not taking aspirin for primary prevention, what should you do?- Know your numbers: Get your blood pressure, cholesterol, and blood sugar checked yearly. Use the AHA’s free “Know Your Risk” tool online.
- Ask about a coronary calcium scan: If you’re 40-60 and have risk factors, this non-invasive CT scan shows if you have plaque buildup. A score over 100 means you’re at real risk.
- Focus on lifestyle: Walking 30 minutes a day, eating more vegetables and less processed food, quitting smoking, and managing stress do more for heart health than any pill.
- Talk to your doctor about statins: For many people with high cholesterol or diabetes, statins are a better first-line option than aspirin. They lower LDL without increasing bleeding risk.
What If You’re Already Taking It?
If you’ve been taking aspirin daily for years and aren’t sure why, don’t stop cold turkey. Talk to your doctor. Abruptly stopping can, in rare cases, trigger a clot. But if you’re over 60, have no heart disease, and no history of heart attack or stent, the evidence strongly suggests you should stop. Many people report feeling better after quitting-less stomach upset, fewer bruises, no more worry about bleeding. A Reddit user, u/HealthyHeart62, wrote: “My doctor took me off aspirin after the 2022 update. I’ve had zero issues since.” That’s the story for most people who stop.Why This Matters More Than You Think
This isn’t just about one pill. It’s about how medicine is changing. We used to believe more intervention was always better. Take a pill for every risk. But now we’re learning that for healthy people, the best medicine might be doing less. Avoiding harm matters as much as preventing disease. The shift away from daily aspirin is part of a larger trend: personalized care over blanket advice. Genetics, imaging, lifestyle, and individual risk profiles are replacing age-based rules. In 2024, researchers started the ASPRIN trial-enrolling 15,000 people with high coronary calcium scores-to finally answer whether aspirin helps this specific group. Results won’t come until 2028. Until then, we work with what we know: for most, the risks outweigh the rewards.Should I take aspirin every day if I’m over 60?
No, if you don’t have heart disease, stroke, or a stent. The U.S. Preventive Services Task Force says the risk of serious bleeding-like stomach or brain bleeds-outweighs any small benefit in preventing a first heart attack. This applies to most adults 60 and older without existing cardiovascular disease.
What if I have high cholesterol or diabetes?
It depends. For people with diabetes aged 40-70, aspirin might be considered only if your 10-year heart disease risk is 15% or higher and you have no bleeding risk factors. Even then, it’s not automatic. A coronary calcium scan (CAC) can help clarify your true risk. If your CAC score is above 100, aspirin may still be reasonable. If it’s low, you’re better off with lifestyle changes and statins.
Can I take aspirin if I’m on blood thinners?
No. If you’re taking warfarin, apixaban, rivaroxaban, or similar drugs, adding aspirin greatly increases your risk of dangerous bleeding. The combination can cause life-threatening internal bleeding. Always tell your doctor about every medication you take, including over-the-counter ones.
What are the signs I’m bleeding because of aspirin?
Watch for black or tarry stools, vomiting blood or material that looks like coffee grounds, unusual bruising, nosebleeds that won’t stop, or sudden headaches with dizziness. These could signal internal bleeding. If you notice any of these, stop aspirin and call your doctor immediately.
I’ve been taking aspirin for years. Should I stop now?
Don’t quit on your own. Talk to your doctor first. If you’ve never had a heart attack, stroke, or stent, and you’re over 60, the odds are you’re better off without it. But if you’ve had a prior event, you’re in secondary prevention-where aspirin is still recommended. Your doctor can review your history and help you decide safely.
Is there a better alternative to aspirin for heart protection?
Yes. For most people, statins are a safer and more effective choice for lowering heart disease risk. They reduce LDL cholesterol without increasing bleeding. Lifestyle changes-like daily walking, eating more vegetables, quitting smoking, and managing stress-are even more powerful. For high-risk patients, a coronary calcium scan can guide whether you need medication at all.
