Aspirin Therapy for Heart Disease Prevention: Who Should Take It in 2025?

For decades, taking a daily low-dose aspirin was one of the most common advice doctors gave to prevent heart attacks - especially if you had a family history or were over 50. But today, that advice has flipped. If you’re asking whether you should still be taking aspirin to keep your heart safe, the answer isn’t simple. It depends on your age, your risk factors, and whether you’ve already had a heart problem. For most healthy people, the risks now outweigh the benefits.

Why Aspirin Was Once a Daily Must

Aspirin works by thinning the blood - not by making it watery, but by stopping platelets from clumping together. That’s important because heart attacks and strokes often happen when a blood clot blocks an artery. Back in the 1980s, studies like the Physicians’ Health Study showed that men taking aspirin had fewer heart attacks. That led to a wave of recommendations. By 2010, nearly 40% of adults in the U.S. between 40 and 75 were taking daily aspirin, often without even talking to their doctor.

But those early studies didn’t account for everything we know now. Today, people manage blood pressure better. Statins are widely used to lower cholesterol. Smoking rates have dropped. Diabetes is more tightly controlled. All of this means the baseline risk of heart disease is lower than it was 30 years ago. And aspirin doesn’t just prevent clots - it can cause dangerous bleeding.

The New Guidelines: What Changed in 2022

In April 2022, the U.S. Preventive Services Task Force (USPSTF) updated its guidelines - and it was a major shift. They no longer recommend aspirin for routine heart disease prevention in adults 60 and older. For those between 40 and 59, it’s only considered if you have a high risk of heart disease and low risk of bleeding - and even then, it’s not automatic.

The key numbers:

• Low-dose aspirin means 75-100 mg per day - often called "baby aspirin."
• For adults 40-59: Only consider aspirin if your 10-year risk of heart disease is 10% or higher, calculated using the ACC/AHA pooled cohort equation.
• For adults 60+: Don’t start aspirin. The risk of bleeding increases with age, and the heart protection doesn’t keep up.
• For adults over 70: The evidence is clear - aspirin causes more harm than good.

These guidelines are backed by large trials like ASPREE, ASCEND, and ARRIVE, which followed over 130,000 people. They found that while aspirin slightly reduced nonfatal heart attacks (by about 12%), it increased the risk of major bleeding by 43%. That includes bleeding in the stomach, brain, or intestines - some of which are life-threatening.

Who Might Still Benefit - And Who Should Avoid It

Not everyone falls into the "don’t take it" category. There are exceptions.

Who might still be a candidate:

• People aged 40-59 with a 10-year CVD risk of 10% or higher - and no bleeding risk factors.
• Those with type 2 diabetes and at least one additional risk factor (like high blood pressure or smoking), according to the American Diabetes Association.
• People with familial hypercholesterolemia - a genetic condition that causes very high cholesterol from birth. Some lipid specialists still recommend aspirin here, even in younger adults.

But even then, it’s not a yes-or-no decision. You need to weigh the numbers.

Who should NOT take aspirin:

• Anyone over 60 without a prior heart attack, stroke, or stent.
• People with a history of stomach ulcers, GI bleeding, or bleeding disorders.
• Those taking blood thinners like warfarin, apixaban, or rivaroxaban.
• People who drink alcohol regularly (more than 2-3 drinks a day).
• Anyone with uncontrolled high blood pressure (above 160/100 mmHg).
• Those with kidney or liver disease.

Doctors use a tool called HAS-BLED to check bleeding risk. A score of 3 or higher means your risk is too high for aspirin.

The Real Cost: Bleeding Risks You Can’t Ignore

Most people think of aspirin as harmless - it’s cheap, it’s over the counter, and Grandma took it every day. But bleeding isn’t rare. In fact, for every 100 people taking low-dose aspirin for 10 years:

• 1 person might avoid a nonfatal heart attack.
• 2 people might have a serious bleeding event - enough to need a hospital stay or blood transfusion.
• 1 in 500 might have a bleeding stroke.

These aren’t theoretical risks. A 2022 study in JAMA Internal Medicine found that aspirin use in adults over 70 caused more bleeding-related deaths than motor vehicle accidents in the same age group. That’s not a small number - it’s a public health concern.

And bleeding doesn’t always come with warning signs. Some people just feel tired. Others notice nosebleeds, bruising easily, or dark stools. These are red flags.

What About Family History?

This is the most common reason people keep taking aspirin: "My dad had a heart attack at 58. I don’t want that to happen to me."

Family history matters - but not enough to override the current evidence. If you’re 65, have no other risk factors, and your cholesterol and blood pressure are normal, your personal risk is still low. Aspirin won’t change that. What will help more:

• Walking 30 minutes a day
• Getting your cholesterol checked
• Stopping smoking
• Taking a statin if your doctor recommends it

Statins reduce heart attack risk by 25-37%. Aspirin reduces it by only 10-15%. And statins don’t cause bleeding. That’s why doctors now prioritize them over aspirin for primary prevention.

What If You’re Already Taking It?

If you’ve been on aspirin for years and have never had a heart attack or stroke, don’t stop cold turkey. Talk to your doctor. Stopping suddenly can trigger a rebound effect - where your blood clots more easily for a short time.

Here’s what to do:

1. Ask your doctor to calculate your 10-year CVD risk using the ACC/AHA calculator.
2. Review your bleeding risk factors - past ulcers, medications, alcohol use.
3. Ask: "Based on my numbers, is the benefit still worth the risk?"
4. If your risk is low and you’re over 60, stopping is likely the safer choice.

Many people are surprised when their doctor says to stop. One Reddit user wrote: "I’ve taken baby aspirin since I was 52. My cardiologist told me to keep going because my dad had a heart attack. I’m 67 now. My risk score is 6%. He still says yes. I’m confused."

That’s the problem - not all doctors are up to date. A 2021 study found only 43% of primary care doctors could correctly calculate CVD risk. So don’t assume your doctor knows the latest guidelines. Bring them up yourself.

Alternatives to Aspirin for Prevention

There’s no magic pill. But there are proven, safer ways to protect your heart:

• Statins - For anyone with high cholesterol, diabetes, or a 10-year risk over 7.5%, this is the first-line defense.
• Blood pressure control - Keeping it below 130/80 reduces heart attack risk by nearly half.
• Exercise - Just 150 minutes a week of brisk walking cuts CVD risk by 30%.
• Healthy diet - Focus on vegetables, whole grains, nuts, fish. Avoid processed meats and sugary drinks.
• Quit smoking - Within 1 year of quitting, your heart attack risk drops by half.

These don’t just prevent heart disease - they prevent cancer, dementia, and diabetes too. Aspirin doesn’t do that.

What About Secondary Prevention?

If you’ve already had a heart attack, stroke, stent, or bypass surgery - aspirin is still a cornerstone of treatment. In these cases, the benefit is clear: it reduces the chance of another event by about 21%.

People in secondary prevention are usually on aspirin for life - unless they have major bleeding complications. That’s not up for debate. The guidelines are consistent: if you’ve had a cardiovascular event, keep taking aspirin unless your doctor says otherwise.

The Bottom Line

Aspirin is not a daily vitamin. It’s a medicine with serious side effects. For healthy people without heart disease, the risks now almost always outweigh the benefits - especially after age 60.

Don’t take it because your parents did. Don’t take it because you read it online. Don’t take it because it’s cheap and easy.

Take it only if:

• You’re between 40 and 59,
• Your 10-year heart disease risk is 10% or higher,
• You have no bleeding risk factors,
• And you’ve talked it through with your doctor.

For everyone else - focus on what actually works: healthy habits, statins if needed, and regular checkups. Your heart doesn’t need aspirin. It needs you to move, eat well, and stay informed.