Should You Take a Daily Aspirin?

Updated July 2026

It's one of the most common questions I hear, and the honest answer has changed in recent years. Aspirin was once handed out almost automatically for heart protection. The latest evidence says it's the right choice for some people and the wrong one for many others, and knowing which group you're in matters.

Why would anyone take aspirin for their heart?

Because it's a mild blood thinner, and blood clots are what turn heart disease deadly. A heart attack or stroke usually begins when atherosclerotic plaque becomes unstable, ruptures, and a clot forms at the site. If the clot is big enough, it can obstruct flow beyond it in a heart artery – that's a heart attack. If a piece of the clot breaks off in a neck artery and travels to the brain – that's a stroke. Aspirin makes that clotting less likely. Since cardiovascular disease is the leading cause of death, heading off those clot-driven events with an inexpensive daily pill can be a genuinely good idea for the right person. (Interestingly, the protection differs a bit by sex: men appear to get more protection against heart attack, women more against stroke.)

What's the downside?

Bleeding, mainly. Aspirin's side effects include allergy, general bleeding risk, stomach irritation and bleeding, and, rarely, bleeding into the brain. True aspirin allergy is uncommon and the overall risk of a serious bleed is low, but that risk rises with age, which is central to the current guidance. Combining aspirin with an NSAID like ibuprofen raises the risk of gastrointestinal complications (both stomach irritation and bleeding) several times over.

Who should take a daily aspirin?

The clear-cut group is people who already have cardiovascular disease. If you've had a heart attack, stroke, bypass surgery, or stent, failed a stress test, or have atherosclerosis documented by imaging like a coronary calcium scan (especially if your calcium score is over 100), the evidence strongly supports a daily low-dose aspirin (usually 81 mg, the "baby" dose), barring a true allergy or a history of dangerous bleeding. This is called secondary prevention, and for these patients nearly all physicians recommend aspirin indefinitely. If this is you and you're not taking aspirin, ask your doctor whether you should be.

What if you don't already have heart disease?

This is where the advice has shifted - and shifted meaningfully. Using aspirin to prevent a first cardiovascular event, called primary prevention, is no longer recommended routinely. Under the current 2022 US Preventive Services Task Force guidance, adults 60 and older should not start aspirin for primary prevention, because the bleeding risk outweighs the benefit. For adults aged 40 to 59 with a 10% or greater 10-year cardiovascular risk, the net benefit is small, so it's an individual decision to make with your doctor, weighing your bleeding risk and your preferences. This lines up with the 2019 American College of Cardiology and American Heart Association guidance that, when it comes to primary prevention, aspirin should be used only infrequently. And for those already taking it, the guidance suggests considering stopping around age 75.

You can estimate your own 10-year risk with the ACC's risk calculator, but please do not start or stop aspirin on your own. Because it's sold over the counter, aspirin is easy to treat casually, but it's still a drug with real effects and real side effects, and the decision deserves a conversation with your physician.

What if aspirin isn't right for you?

Then focus on the thing aspirin can't do. Remember what aspirin is actually for: it reduces the chance of downstream damage once plaque has already become unstable. What makes plaque unstable in the first place is high cholesterol, high blood pressure, high blood sugar, smoking, and chronic stress, and the chance of that happening drops dramatically when you eat well, move your body, don't smoke, and manage stress. No amount of blood thinning substitutes for those fundamentals. Helping with the "eat well" part is exactly why Step One Foods exists.

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