Aspirin for Primary Prevention: Who Should Skip Daily Doses

For years, taking a daily low-dose aspirin was like brushing your teeth - something you did just to stay healthy. But that advice has changed. Big time. If you’re over 60 and have never had a heart attack or stroke, the latest science says: skip the aspirin. Not because it doesn’t work, but because the risks now outweigh the benefits for most people.

Why the Big Change?

Back in the 1990s, studies like the Physicians’ Health Study showed aspirin could cut heart attack risk by about 44% in middle-aged men. That led to millions of people popping a pill every day, even if they had no heart disease. But those early studies didn’t fully account for the hidden cost: bleeding.

Fast forward to 2025, and we have better data. Large trials like ASPREE and ASCEND tracked over 25,000 people over 10 years. The results? Aspirin lowers the chance of a first heart attack by a tiny amount - about 1 in 100 people over 10 years. But it increases the risk of serious bleeding by nearly 1 in 70. That’s not a trade-off most people should make.

The U.S. Preventive Services Task Force (USPSTF) flipped its recommendation in 2022. Now, they say: do not start aspirin for primary prevention if you’re 60 or older. The American Heart Association and American College of Cardiology agree. Even the European Society of Cardiology says don’t bother at any age, unless you’ve already had a heart event.

Who Should Definitely Skip Aspirin

If you fall into any of these groups, daily aspirin is more likely to hurt you than help:

• Age 60 or older - This is the clearest cutoff. For people in this group, the risk of brain or stomach bleeding rises sharply with age. Studies show 1.6 extra major bleeding events per 1,000 people each year - and only 0.9 fewer heart attacks. That’s a net loss.
• History of stomach ulcers or GI bleeding - Even one past ulcer increases your bleeding risk by 3 to 5 times. Aspirin irritates the stomach lining. If you’ve had bleeding before, don’t restart.
• Taking blood thinners like warfarin, apixaban, or rivaroxaban - Combining these with aspirin doubles or triples your bleeding risk. No exceptions.
• Regular NSAID users - If you take ibuprofen or naproxen for arthritis or back pain, aspirin adds fuel to the fire. About 18% of adults over 65 take NSAIDs regularly. That’s a dangerous combo.
• High risk of falls or frailty - Even a minor bump can turn into a dangerous brain bleed if you’re on aspirin. This is especially true for older adults with balance issues or osteoporosis.

Who Might Still Benefit (But Only After Deep Discussion)

There’s a small group - mostly people aged 40 to 59 - where aspirin might still make sense. But it’s not automatic. You need to pass three tests:

1. 10-year CVD risk ≥10% - Use the ACC/AHA Pooled Cohort Equations. This tool looks at your age, sex, race, cholesterol, blood pressure, diabetes, and smoking status. If your score is below 10%, skip aspirin.
2. No increased bleeding risk - No ulcers, no blood thinners, no history of bleeding. Even a single episode of nosebleeds or blood in stool counts.
3. Willing to take it for at least 10 years - Benefits only show up after 5+ years. If you’ll quit after a year, there’s no point.

Even then, it’s not a guarantee. A 2023 study in JAMA Internal Medicine found that among people with a 12% 10-year risk, only 1 in 120 avoided a heart attack over 10 years - while 1 in 110 had a major bleed. That’s almost a coin flip.

What About Diabetes?

People with diabetes were once thought to be prime candidates for aspirin. After all, they have higher heart disease risk. But new guidelines from the AHA/ACC in 2025 changed that too.

Now, aspirin is only considered for diabetics aged 40-70 with a 10-year ASCVD risk of 15% or higher - and only if they have no bleeding risk. That’s a narrow window. Many diabetics don’t hit that risk threshold. And if they’re on other meds or have kidney issues, aspirin is still a no-go.

Some experts argue that if you have a coronary calcium score over 100 (meaning you have plaque in your arteries), aspirin might help. But that’s still debated. No major guideline endorses it yet. And the trial testing this exact question - ASPRIN - won’t finish until 2028.

Why So Much Confusion?

You’re not imagining it. Many people get conflicting advice. Why?

• Doctors don’t all read the same guidelines. Cardiologists are more likely to keep prescribing aspirin than primary care doctors. A 2023 survey found 41% of adults over 60 still take it daily - even after the 2022 update.
• Patients are scared to stop. One patient on Reddit wrote: “My doctor took me off aspirin. I was terrified I’d have a heart attack.” But for most, stopping didn’t cause problems - and their stomach felt better.
• Marketing still lingers. You still see ads saying “Aspirin helps prevent heart attacks.” They don’t mention the bleeding risk. That’s misleading.

A 2023 JAMA study found 57% of patients reported their doctors gave them conflicting advice. That’s not because doctors are wrong - it’s because the science changed fast, and not everyone caught up.

What Should You Do?

If you’re on daily aspirin and have never had a heart attack or stroke:

• Don’t quit cold turkey. Stopping suddenly can cause rebound clotting. Talk to your doctor first.
• Ask for your 10-year CVD risk score. If it’s below 10%, you’re almost certainly better off stopping.
• Ask about bleeding risk. Do you have a history of ulcers? Are you on NSAIDs? Do you fall often?
• Ask if you’ve had a calcium score test. If you have high plaque buildup, that might change the conversation - but it’s not a green light.

If you’re not on aspirin and never had heart disease:

• Don’t start. Unless you’re under 60, have a high CVD risk, and zero bleeding risk - and you’ve talked it through with your doctor - don’t begin.

What Are the Alternatives?

Aspirin isn’t the only way to protect your heart. In fact, the real winners are simpler, safer, and more effective:

• Quit smoking - This cuts heart disease risk by half within a year.
• Control blood pressure - Keeping it under 120/80 reduces stroke risk more than aspirin ever could.
• Lower LDL cholesterol - Statins are proven to prevent first heart attacks - and they don’t cause stomach bleeds.
• Exercise 150 minutes a week - Walking, swimming, cycling - any movement helps.
• Eat more plants, less processed food - Diets rich in vegetables, nuts, and whole grains reduce heart disease risk by up to 30%.

These don’t come with warning labels. They don’t cost money. And they work for everyone - no matter your age or risk level.

Final Thought

Aspirin isn’t evil. For someone who’s had a heart attack, it’s life-saving. But for someone who’s healthy? It’s a gamble with your stomach, your brain, and your gut. The data is clear: the era of daily aspirin for prevention is over.

If you’re unsure, ask your doctor: “Based on my risk and my bleeding risk, does aspirin still make sense for me?” If they say yes without checking your calcium score or your NSAID use - get a second opinion.

Your heart doesn’t need aspirin. It needs better sleep, less stress, movement, and real food. Those are the real preventive medicines.