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

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 likely told you to pop a baby aspirin. But that advice has changed-dramatically. As of 2025, most healthy adults should no longer take aspirin to prevent their first heart attack or stroke. The science has caught up with reality: for many people, the risks now clearly outweigh the benefits.

Why Aspirin Was Once a Daily Must

Aspirin works by stopping platelets from clumping together. That’s useful when a clot blocks an artery and causes a heart attack or stroke. Back in the 1980s and 1990s, big studies like the Physicians’ Health Study showed that men taking aspirin had fewer heart attacks. That led to widespread recommendations. By 2010, nearly 40% of U.S. adults aged 40-75 were taking daily aspirin for prevention-even if they had never had a heart problem.

But those early studies didn’t account for modern medicine. Today, we have better blood pressure control, more effective cholesterol-lowering drugs like statins, and fewer people smoking. These changes alone have cut heart disease risk by 30-40%. Aspirin’s benefit-about a 10-15% reduction in heart attacks-is now much smaller in comparison. Meanwhile, its biggest risk, serious bleeding, hasn’t gone away.

The New Guidelines: Who Should Still Consider Aspirin?

The latest guidelines from the U.S. Preventive Services Task Force (USPSTF), updated in 2022, are clear: aspirin therapy is no longer recommended for routine primary prevention in adults over 60. For adults aged 40-59 with a high risk of heart disease, it’s a personal decision-only if the benefits clearly outweigh the risks.

Here’s how to know if you’re in that group:

1. You’re between 40 and 59 years old
2. Your 10-year risk of heart disease is 10% or higher
3. You have no history of bleeding problems
4. You’re not already on blood thinners

Your 10-year risk is calculated using the ACC/AHA Pooled Cohort Equation. It uses your age, sex, race, blood pressure, cholesterol levels, diabetes status, and smoking habits. Most doctors can run this in under 2 minutes using their electronic health record system. If your score is below 7.5%, aspirin isn’t recommended. If it’s between 7.5% and 10%, the benefit is small and likely not worth the risk.

There’s one exception: people with familial hypercholesterolemia. These individuals have extremely high LDL cholesterol from birth and are at very high risk for early heart disease. Many lipid specialists still recommend aspirin for them, even if they’re under 40.

Who Should Avoid Aspirin Completely?

If any of these apply to you, don’t start aspirin-and talk to your doctor if you’re already taking it:

• You’re 60 or older
• You’ve had a stomach ulcer or GI bleeding in the past
• You take other blood thinners like warfarin, apixaban, or rivaroxaban
• You drink more than 3 alcoholic drinks a day
• You have kidney or liver disease
• You’re over 70-even if you’re otherwise healthy

For people over 60, the data is clear: aspirin doesn’t prevent heart attacks enough to justify the bleeding risk. A major 2018 study called ASPREE followed nearly 20,000 adults over 70. Those taking aspirin had the same number of heart attacks as those taking a placebo-but more major bleeding events, including brain bleeds and fatal gastrointestinal bleeds.

Even if you feel fine, bleeding doesn’t always come with warning signs. Some people don’t realize they’re bleeding internally until they collapse. Others notice nosebleeds, bruising easily, or dark, tarry stools. These aren’t normal. They’re red flags.

Aspirin’s Real Numbers: Benefits vs. Risks

Let’s put this in plain terms. For every 100 people like you who take low-dose aspirin daily for 10 years:

• 1 person might avoid a nonfatal heart attack
• 1 person might avoid a nonfatal stroke
• 2 people will have a serious bleeding event requiring hospitalization or a blood transfusion

That’s not a good trade. And the bleeding risk doesn’t go down with time-it goes up. The older you get, the more likely you are to bleed. That’s why guidelines now say: if you’re over 60, don’t start. If you’re already on it, talk to your doctor about stopping.

Aspirin’s benefit is strongest in people with diabetes and other risk factors. The American Diabetes Association still recommends aspirin for adults over 40 with diabetes who have at least one additional risk factor-like high blood pressure or smoking. But even here, the recommendation is cautious. It’s not automatic. It’s a discussion.

What About Family History?

“My dad had a heart attack at 58-I need aspirin.” This is the most common reason people give for continuing aspirin. But family history alone isn’t enough to justify it.

Genetics play a role, yes. But your own risk factors matter more. If you don’t smoke, your blood pressure is normal, your cholesterol is under control, and you exercise regularly, your personal risk may be low-even with a strong family history. Taking aspirin won’t cancel out your genes. It might just give you a bleeding ulcer.

Instead of relying on family history, get your 10-year risk calculated. That’s the only objective way to know if aspirin helps you.

Aspirin vs. Statins: Which One Actually Works?

Statins-drugs like atorvastatin and rosuvastatin-are now the cornerstone of heart disease prevention. They lower LDL cholesterol, stabilize plaque in arteries, and reduce inflammation. In large trials, statins cut heart attack risk by 25-37%. Aspirin? About 10-15%.

And statins don’t increase bleeding risk. They’re safer for long-term use in healthy people. If you’re at high risk for heart disease, you should be on a statin first. Aspirin, if used at all, is a secondary tool-not the main one.

Many people take both. That’s fine-if your doctor recommends it. But if you’re only taking aspirin and not a statin, you’re missing the bigger, more effective piece of the puzzle.

What If You’re Already Taking Aspirin?

If you’re over 60 and taking aspirin for prevention, don’t stop cold turkey. Talk to your doctor. Stopping suddenly can cause rebound platelet activation, which may slightly increase short-term risk. But that risk is far smaller than the long-term bleeding risk.

Your doctor will likely:

1. Check your 10-year CVD risk
2. Review your bleeding risk factors
3. Assess whether you’re on other medications that increase bleeding (like NSAIDs or SSRIs)
4. Discuss your personal values: Are you more afraid of a heart attack or a bleed?

If your risk is low and you have no clear benefit, stopping aspirin is the safest move. Many people feel better after stopping-no more stomach upset, fewer nosebleeds, less anxiety about bleeding.

What About Low-Dose vs. Regular Aspirin?

For prevention, the dose matters. The standard recommendation is 75-100 mg daily. That’s one baby aspirin (81 mg in the U.S.) or a quarter of a regular aspirin (325 mg). Higher doses don’t offer more protection-they just increase bleeding risk.

Don’t take 325 mg unless your doctor specifically tells you to. That dose is for heart attack recovery, not prevention.

Alternatives to Aspirin for Prevention

If you’re looking to reduce your heart disease risk, focus on what actually works:

• Take a statin if your risk is high
• Keep blood pressure under 120/80
• Get your LDL cholesterol below 70 if you’re high risk
• Exercise 150 minutes a week
• Stop smoking
• Manage diabetes tightly
• Eat more vegetables, whole grains, and healthy fats

These changes reduce your risk by 50% or more. Aspirin? At best, 10-15%. Lifestyle isn’t glamorous, but it’s proven.

Bottom Line: Aspirin Isn’t for Everyone Anymore

Aspirin isn’t a magic bullet. It’s a tool-with serious side effects. For most people, especially those over 60, it does more harm than good. The days of automatic daily aspirin are over.

If you’re under 60 and have high heart disease risk, talk to your doctor. Maybe aspirin makes sense for you. But don’t assume it does. Get your numbers checked. Understand your bleeding risk. Weigh the real numbers-not fear, not family history, not old advice.

If you’re over 60 and taking aspirin without a clear reason, it’s time to have that conversation. Your heart might be fine. But your stomach, your brain, your gut-those might not be.