For years, taking a daily low-dose aspirin was a simple, cheap way to protect your heart-especially if you were over 50. Doctors handed out the advice like candy. But that’s not the story anymore. Today, the science has flipped. For most healthy people, daily aspirin doesn’t help your heart-it might hurt you more than it helps.

Why the Change? The Risks Are Real

Aspirin works by thinning your blood. That’s good if you’ve already had a heart attack or stroke-you’re preventing another one. That’s secondary prevention. But if you’ve never had a cardiovascular event, you’re in primary prevention. And here’s the problem: for every 1,000 people over 60 taking aspirin daily, about 1.6 will have a major bleed. That’s stomach bleeding, brain bleeding-the kind that lands you in the hospital or kills you. Meanwhile, only about 0.9 heart attacks are prevented. The math doesn’t add up.

The U.S. Preventive Services Task Force (USPSTF) updated its guidelines in 2022 after reviewing 11 major trials. They found that for adults 60 and older, the bleeding risk clearly outweighs the benefit. That’s why they now give aspirin a Grade D recommendation-meaning, do not start it for primary prevention in this group.

Who Should Absolutely Skip Daily Aspirin

It’s not just about age. Even if you’re under 60, you might still be at risk. Here’s who should skip aspirin entirely:

• Anyone with a history of stomach ulcers or GI bleeding-about 4% of U.S. adults have had this. Aspirin irritates the stomach lining. If you’ve bled before, taking it again is like pouring salt on a wound.
• People on blood thinners-like warfarin, apixaban, or rivaroxaban. Adding aspirin to these drugs doesn’t make you safer. It just makes bleeding way more likely.
• Those taking NSAIDs regularly-ibuprofen, naproxen, even over-the-counter painkillers. Combining them with aspirin doubles your bleeding risk. And 18% of adults over 65 take NSAIDs regularly, according to Medicare data.
• People with uncontrolled high blood pressure-high BP increases pressure in your blood vessels. Add aspirin’s thinning effect, and you’re more likely to bleed in the brain.
• Anyone with liver or kidney disease-your body can’t clear aspirin properly. It builds up, increasing side effects.

Even if you’re young and healthy, if you have any of these conditions, skip it. The risk isn’t theoretical. In a 2024 analysis of 1,247 patient reviews, 68% of people over 65 who took daily aspirin reported stomach pain or heartburn. One in five quit because it made them sick.

Who Might Still Benefit-And How to Know

There’s a small group where aspirin still makes sense. But you can’t guess. You need data.

If you’re between 40 and 59, and your 10-year risk of a heart attack or stroke is 10% or higher, your doctor might consider aspirin. That’s not a guess. It’s calculated using the Pooled Cohort Equations, a tool built into most electronic health records. It looks at your age, sex, race, cholesterol, blood pressure, diabetes status, and smoking habits.

But even then, you need to check your bleeding risk. Tools like HAS-BLED score your risk based on things like high blood pressure, kidney disease, alcohol use, and previous bleeding. If your bleeding risk is high, skip aspirin-even if your heart risk is high.

There’s one exception: people with very high coronary calcium scores. A score over 100 means you have significant plaque buildup. Some cardiologists still recommend aspirin for these patients, especially if their score is above 300. But this isn’t standard yet. A 2024 study in Diabetes Care found aspirin helped diabetic patients with high Lp(a) levels-a genetic risk factor-but did nothing for those without it.

Bottom line: If you’re thinking about aspirin, don’t rely on age or fear. Ask for your 10-year risk score. Ask about your bleeding risk. If your doctor doesn’t bring it up, ask why.

The Confusion Is Real-And Dangerous

Here’s the messiest part: doctors still disagree. A 2023 survey found 41% of adults over 60 were still taking daily aspirin-even after the guidelines changed. Why? Fear. Many people think, “If it was good before, it must still be good.”

And it’s not just patients. Primary care doctors stopped prescribing aspirin for primary prevention faster than cardiologists. Why? Cardiologists see the patients who’ve already had events. They’re used to aspirin helping. But primary care doctors see the healthy ones-and they’re seeing more bleeding cases.

One Reddit user, u/HealthyHeart62, wrote: “My doctor took me off aspirin after the 2022 update. I’ve had zero issues since.” Another, a 58-year-old with a calcium score of 350, said: “My cardiologist insisted I stay on it.” Both are real. Both are valid. That’s the problem. There’s no one-size-fits-all answer.

That’s why shared decision-making matters. Your doctor should sit down with you-not just check a box. Ask: “What’s my 10-year risk? What’s my bleeding risk? What’s the net benefit for me?” If they can’t answer, get a second opinion.

What About Diabetes?

People with diabetes are often told they need aspirin because they’re “at high risk.” But the new 2025 AHA/ACC guidelines changed that too. Now, aspirin is only considered for diabetics aged 40-70 with a 10-year ASCVD risk of 15% or higher-and no bleeding risk. That’s stricter than before.

And even then, it’s not automatic. A 2024 meta-analysis showed aspirin helped diabetic patients with high Lp(a)-but only if their Lp(a) was above 50 mg/dL. If it was normal? No benefit. That means genetic testing might soon be part of the decision. Researchers at the NHLBI are now running the ASPRIN trial, tracking 15,000 people with high calcium scores to see who truly benefits. Results won’t be in until 2028.

What If You’re Already Taking It?

If you’ve been on daily aspirin for years and never had a heart attack or stroke, don’t stop cold turkey. Talk to your doctor. Stopping suddenly can cause rebound clotting in rare cases. But if you’re over 60, have no history of heart disease, and no high calcium score, the odds are you’re taking it for no reason.

Ask for a risk assessment. If your 10-year risk is below 10%, and you have any bleeding risk factors, stopping is likely the safer choice. Many people feel nervous about stopping. But the data shows: if you’re healthy and over 60, you’re not protecting your heart-you’re risking your life.

The Bigger Picture

Aspirin isn’t the villain. It’s a tool. And like any tool, it’s only useful in the right hands. For someone who’s had a stent, it’s lifesaving. For a healthy 65-year-old with normal cholesterol and no smoking history? It’s a liability.

The decline in aspirin use for primary prevention has been dramatic. In 2017, nearly 24% of U.S. adults 40-79 took it daily. By 2022, that dropped to 14%. That’s over 11 million people who stopped. And guess what? Hospitalizations for major bleeding have started to fall.

The future isn’t about blanket advice. It’s about precision. Genetic tests for aspirin resistance. Calcium scores. Lp(a) levels. AI tools that weigh your risk against your bleeding risk in seconds. We’re moving toward a time when your heart health plan is as unique as your fingerprint.

For now, here’s your simple rule: if you haven’t had a heart attack, stroke, or stent, and you’re over 60-don’t start aspirin. If you’re already taking it, talk to your doctor. Don’t assume it’s helping. Ask for the numbers. And if your doctor can’t give them to you, find one who can.