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

For decades, taking a daily low-dose aspirin was something millions of people did without thinking - like brushing their teeth. It was the go-to move for preventing heart attacks, especially if you had a family history or were over 50. But here’s the truth: aspirin therapy for heart disease prevention isn’t what it used to be. In 2025, the advice has flipped. For most healthy adults, taking aspirin daily to prevent a first heart attack or stroke is no longer recommended - and in some cases, it could be dangerous.

Why Aspirin Was Once a No-Brainer

Aspirin works by thinning the blood. It blocks a chemical in platelets that makes them stick together and form clots. If a clot blocks an artery in your heart or brain, it can cause a heart attack or stroke. For people who already had one, aspirin cuts the chance of another by about 21%. That’s why it’s still a cornerstone of secondary prevention - meaning after you’ve had a heart event.

But for people without any history of heart disease? The math changed. Back in the 1980s and 90s, studies like the Physicians’ Health Study showed aspirin reduced heart attacks in men. That led to widespread adoption. But those studies were done before statins, before blood pressure meds were as good, before we understood how much smoking, diet, and exercise matter. Today, people manage their risk better. And the bleeding risk from aspirin? It’s real - and growing.

Who Should Still Consider Aspirin? (The Narrow Group)

The 2022 US Preventive Services Task Force (USPSTF) guidelines are clear: don’t start aspirin if you’re 60 or older. Period. For adults between 40 and 59, it’s not a blanket yes. It’s a maybe - and only if you meet very specific conditions.

You might consider aspirin if:

• You’re between 40 and 59 years old
• Your 10-year risk of heart disease is 10% or higher
• You have no increased risk of bleeding
• You’re willing to take it for at least 10 years

How do you know your 10-year risk? Doctors use a tool called the ACC/AHA pooled cohort equation. It asks for your age, sex, race, blood pressure, cholesterol levels, whether you have diabetes, and if you smoke. You can’t guess this. You need your latest lab results and a doctor’s input.

For example: a 55-year-old man with high LDL cholesterol, untreated high blood pressure, and who smokes might hit that 10% threshold. A 52-year-old woman with normal numbers and no smoking history? Probably not. That’s why blanket advice doesn’t work.

Who Should Avoid Aspirin Completely?

Aspirin isn’t harmless. It’s a drug with serious side effects - especially for older adults.

Stop or never start aspirin if you have:

• A history of stomach ulcers or GI bleeding
• Active liver or kidney disease
• Use of blood thinners like warfarin or apixaban
• Uncontrolled high blood pressure
• Age 60 or older (even if you think you’re healthy)
• Drink alcohol regularly (more than 2-3 drinks a day)

The HAS-BLED score is a simple checklist doctors use to spot bleeding risk. If you score 3 or higher, aspirin is a bad idea. Even one of these factors - like being over 65 or on NSAIDs like ibuprofen - can tip the scales.

Here’s what the numbers show: for every 100 people like you taking aspirin daily for 10 years, about 1 might avoid a heart attack. But 2 might have a major bleeding event - like a stomach bleed or brain hemorrhage - that requires hospitalization or a blood transfusion. That’s not a trade-off most people want to make.

What About Diabetes or Family History?

Many people think: “My dad had a heart attack at 58. I should take aspirin.” Or “I have type 2 diabetes - doesn’t that mean I need it?”

The answer? Maybe - but not automatically.

The American Diabetes Association says aspirin can be considered for people with diabetes over 40 who have additional risk factors - like high blood pressure, smoking, or kidney disease. But even then, it’s not a default. A 2020 study in Atherosclerosis found that in people with diabetes and low coronary calcium scores, aspirin offered no benefit. In those with high scores? Possibly. But you need a scan to know.

Family history alone? Not enough. Genetics matter, but they don’t override bleeding risk. A 62-year-old with a strong family history but normal cholesterol, no smoking, and no high blood pressure has a low overall risk. For them, aspirin does more harm than good.

What Are the Real Alternatives?

If aspirin isn’t the answer for primary prevention, what is?

Statins. That’s it. For most people, the best way to prevent a first heart attack is to lower cholesterol with a statin like atorvastatin or rosuvastatin. They reduce heart attack risk by 25-37% - far more than aspirin’s 10-15%. And they don’t cause bleeding.

Other proven tools:

• Keeping blood pressure under 130/80
• Walking 150 minutes a week
• Stopping smoking
• Eating more vegetables, nuts, whole grains
• Losing excess weight

These aren’t just “lifestyle tips.” They’re medical interventions with stronger evidence than aspirin for people without heart disease. And they come with zero bleeding risk.

Why Are So Many People Still Taking It?

Despite the guidelines, an estimated 22 million Americans still take daily aspirin for primary prevention. Why?

Old habits die hard. Many people were told to take it by a doctor 15 years ago - and never got an update. Others rely on anecdotal stories: “My neighbor took it for 30 years and never had a heart attack.” Or “My cardiologist said keep going because of my family history.”

But doctors aren’t always up to date. A 2021 study found only 43% of primary care physicians could correctly calculate a patient’s 10-year heart risk. Many still default to prescribing aspirin because it’s cheap, familiar, and patients expect it.

On Reddit and health forums, you’ll see people debating whether to stop. One user wrote: “I stopped aspirin at 67 after my doctor said I shouldn’t take it. I had three nosebleeds in six months - I thought it was the aspirin. Turns out it was dry winter air. But I was terrified.” Another said: “I had a heart attack at 68. I’ve taken aspirin since 55. My doctor says I owe it to the aspirin.”

These stories sound convincing. But they’re not data. They’re survivorship bias - you only hear from the people who made it. You don’t hear from the ones who bled out.

What If You’re Already Taking Aspirin?

If you’re currently taking daily aspirin and you’re over 60 - or you have any bleeding risk - talk to your doctor. Don’t stop cold turkey. Abruptly stopping aspirin can, in rare cases, trigger a rebound clotting effect. But if you’re over 60 with no heart disease, the odds are you’re better off without it.

If you’re under 60 and have no risk factors? You probably don’t need it. If you’re under 60 and have high risk? Ask your doctor to run your 10-year score. If it’s below 10%, skip it. If it’s above 10%, discuss the pros and cons - not just with your doctor, but with yourself.

Ask yourself: Do I understand the bleeding risk? Am I okay with a 1 in 50 chance of a serious bleed over 10 years to get a 1 in 100 chance of avoiding a heart attack? If you’re not sure, don’t take it.

Bottom Line: Aspirin Isn’t a Vitamin

Aspirin is not a supplement. It’s a drug. It has risks. It has benefits. And for most healthy people in 2025, the risks outweigh the benefits.

The era of “take a baby aspirin every day” is over. What’s replacing it? Better risk assessment. Better cholesterol control. Better lifestyle habits. And a shift away from one-size-fits-all medicine.

If you’re unsure, don’t guess. Get your 10-year risk calculated. Get your bleeding risk checked. Talk to your doctor - not about what you’ve heard on the internet, but about your actual numbers. Your heart might thank you. So might your stomach.