For decades, taking a daily aspirin was a simple, cheap way to protect your heart. If your parent had a heart attack, your doctor likely told you to pop a baby aspirin every morning. But that advice has changed - dramatically. As of 2025, aspirin therapy is no longer a one-size-fits-all solution for preventing heart disease. In fact, for most healthy adults, it’s no longer recommended at all.

Why the Big Change?

Aspirin works by thinning your blood. It stops platelets from clumping together, which can block arteries and cause heart attacks or strokes. That sounds great - until you realize it also increases your risk of dangerous bleeding. For years, doctors assumed the benefits outweighed the risks. But large, modern studies from 2018 onward changed everything.

The ASPREE, ASCEND, and ARRIVE trials followed over 100,000 people for years. The results were clear: in people without existing heart disease, aspirin reduced heart attacks by only about 10-15%. But it increased the risk of serious bleeding - like stomach bleeds or brain hemorrhages - by nearly 43%. For many, the harm was greater than the help.

Modern medicine has also gotten better at preventing heart disease. Statins lower cholesterol more effectively. Blood pressure meds control hypertension. Lifestyle changes like quitting smoking and eating better reduce risk more than aspirin ever did. So the bar for adding aspirin has gotten much higher.

Who Might Still Benefit?

The latest guidelines from the U.S. Preventive Services Task Force (USPSTF) and the American College of Cardiology say aspirin might still make sense for a small group: adults aged 40 to 59 with a high risk of heart disease and low risk of bleeding.

How do you know if you’re in that group? Your doctor calculates your 10-year cardiovascular disease risk using something called the Pooled Cohort Equation. It looks at:

• Your age and sex
• Your race
• Total and HDL cholesterol
• Systolic blood pressure (even if you’re on meds)
• Whether you have diabetes
• Whether you smoke

If your calculated risk is 10% or higher, and you don’t have bleeding risk factors, your doctor might suggest trying low-dose aspirin (75-100 mg daily). But even then, it’s not automatic. It’s a conversation.

Who Should Avoid Aspirin Completely?

If you’re 60 or older, the USPSTF says do not start aspirin for heart disease prevention. The bleeding risk rises sharply with age, and the heart benefits don’t keep up. A 65-year-old with no heart history gains almost no protection from aspirin - but their chance of a major bleed goes up.

Also avoid aspirin if you have:

• A history of stomach ulcers or GI bleeding
• Active liver or kidney disease
• Been on blood thinners like warfarin or apixaban
• Drink more than 3 alcoholic drinks a day
• A bleeding disorder like hemophilia
• A HAS-BLED score of 3 or higher (a tool doctors use to measure bleeding risk)

Even if you’re young and healthy, if you’re on NSAIDs like ibuprofen regularly, aspirin can irritate your stomach lining and increase bleeding risk. Talk to your doctor before combining them.

What About Diabetes?

People with diabetes have a higher risk of heart disease. The American Diabetes Association still says aspirin can be considered for those over 40 with additional risk factors - like high blood pressure or smoking. But even here, it’s not automatic. A 2022 study in the Journal of the American College of Cardiology found that for many diabetic patients without prior heart events, the bleeding risk still outweighed the benefit.

Some experts now recommend checking coronary artery calcium (CAC) scores in diabetic patients. If the score is high (above 100), aspirin might make sense. If it’s zero, skip it. This personalized approach is becoming the new standard.

What About Family History?

A lot of people keep taking aspirin because their parent had a heart attack young. But genetics alone aren’t enough to justify it. If you’re 62, have normal cholesterol, no high blood pressure, and don’t smoke - your family history doesn’t change the math. The risk of bleeding still outweighs the benefit.

One 2021 study found that 68% of people over 60 who took aspirin for prevention did so because of family history. But their actual risk profile didn’t match the guidelines. That’s why shared decision-making matters. Your doctor shouldn’t just say, “Your dad had a heart attack, so take aspirin.” They should say, “Here’s your actual risk. Here’s your bleeding risk. Here’s what the data says.”

What If You’re Already Taking It?

If you’re over 60 and have never had a heart attack, stroke, stent, or bypass, the current advice is to stop. Don’t quit cold turkey without talking to your doctor - but don’t keep taking it just because “it’s been years.”

Many people who stop report feeling anxious at first. But in follow-ups, most feel better knowing they’re not risking a bleed for no benefit. One woman in Seattle, 67, stopped her daily aspirin after her doctor ran her risk numbers. She’d been taking it since 55 because her dad died of a heart attack. Her 10-year risk? 6%. Bleeding risk? High due to occasional NSAID use. She stopped. No heart issues since. No nosebleeds either.

If you’ve had a heart attack, stent, or bypass, keep taking aspirin. It’s proven to save lives in secondary prevention. For those patients, aspirin reduces the chance of another event by about 21%. The bleeding risk is real, but the benefit is clear.

What Are the Alternatives?

Aspirin isn’t the only tool. Statins are now the cornerstone of prevention. Atorvastatin (Lipitor) and rosuvastatin (Crestor) reduce LDL cholesterol by 30-50% and lower heart attack risk by 25-37%. That’s better than aspirin - and without the bleeding risk.

For people with high blood pressure, ACE inhibitors or ARBs are first-line. For high cholesterol, PCSK9 inhibitors (like Repatha) are powerful options. Lifestyle changes - a Mediterranean diet, 150 minutes of exercise a week, no smoking - are more effective than any pill for most people.

Aspirin’s only real advantage is cost. A 3-month supply of generic aspirin costs $4-$6. But when you factor in ER visits for bleeding, hospital stays, and lost workdays, the real cost of unnecessary aspirin use is much higher.

How to Talk to Your Doctor

If you’re unsure whether aspirin is right for you, ask these questions:

• What’s my 10-year risk of heart disease using the Pooled Cohort Equation?
• What’s my bleeding risk? Do I have any risk factors like ulcers, NSAID use, or heavy drinking?
• Am I on statins or other heart meds? Are they enough?
• Has my risk changed since I started aspirin?
• What happens if I stop? What happens if I keep going?

Bring your latest blood work, blood pressure readings, and a list of all meds and supplements. Many doctors still default to prescribing aspirin out of habit. Be prepared to ask for the data.

The Bottom Line

Aspirin isn’t a magic bullet. It’s a tool - and like any tool, it’s only useful in the right hands. For most people in 2025, it’s not the right tool for heart disease prevention. The era of blanket aspirin prescriptions is over.

If you’re under 60, have high heart risk, and low bleeding risk - talk to your doctor. If you’re over 60 and have never had a heart event - talk to your doctor about stopping. If you’ve had a heart attack or stent - keep taking it. And for everyone else: focus on statins, blood pressure control, and lifestyle. Those are what actually move the needle now.