Should you take a daily aspirin in hopes of reducing your risk of a heart attack or stroke? It was once common medical advice. But the answer today is: It really depends. Start by talking with your doctor. Medical recommendations change over time and so does your health. Most importantly, make sure you talk with your doctor each year about each of your medications — including over-the-counter ones.
A recent study shows that almost half of adults aren’t aware of the current recommendations about daily aspirin.
Doctors used to recommend that healthy older adults take a low-dose daily aspirin to reduce their risk of heart attack or stroke. Eight years ago, 30 million U.S. adults over the age of 40 reported that they regularly took aspirin for this purpose.
Recommendations have changed, though. In 2019, the American College of Cardiology and American Heart Association (ACC/AHA) issued new guidelines about daily aspirin, and in 2022, the national panel of experts on the U.S, Preventive Services Taskforce did too.
Guidance and expertise to keep your heart strong and healthy.
What are the latest recommendations for aspirin and heart health?
It depends on your health history.
If you’ve never had a heart attack or stroke:
Instead of recommending low-dose daily aspirin for everyone in certain age and cardiovascular risk groups, a federal task force now recommends talking with your doctor to assess the risks and benefits of daily aspirin.
That’s because there are risks of taking aspirin. We’ll get into those in a minute.
The U.S. Preventive Services Task Force also says this:
- If you’re 40 to 59, with a high risk of having a heart attack or stroke for the first time sometime during the next 10 years: the overall “net benefit” (the remaining benefits after risks are taken into account) of aspirin use in this group is small. But if you don’t have an increased risk of bleeding, you may benefit.
- If you’re 60 or older: Don’t start taking aspirin to prevent cardiovascular disease.
These recommendations align with the ACC/AHA’s 2019 recommendation that aspirin should be used “infrequently” to prevent cardiovascular disease in someone who doesn’t already have it.
If you’ve had a heart attack, ischemic stroke or related complications, should you take a daily aspirin?
Probably yes. That group specifically would include those who’ve had a heart attack or ischemic stroke or certain heart procedures or heart conditions.
If this describes you, your doctor is likely to recommend daily aspirin for the rest of your life to prevent future heart attacks or strokes, said cardiothoracic surgeon Dr. John Perry of Novant Health Cardiovascular and Thoracic Surgery at Hilton Head Medical Center. For this group, Perry said, daily aspirin is “not without risks, but it’s a much lower risk” than other common medications that could prevent future clots from forming, and is usually well-tolerated. The ACC/AHA echoes this recommendation.
How does aspirin help prevent stroke or heart disease?
Aspirin is an “antiplatelet” drug. This means it can prevent platelets in your blood from sticking together and clotting, which could prevent an ischemic stroke or heart attack down the line. This is part of why doctors recommend taking aspirin during a heart attack.
Ischemic strokes, which occur when a blood vessel to the brain is obstructed, account for 87% of strokes. Hemorrhagic strokes, which occur when a blood vessel in the brain bursts and bleeds, are not prevented by daily aspirin use.
What are the risks of taking aspirin daily?
Increased bleeding risk
Aspirin increases bleeding risk, especially in the gastrointestinal tract. Patients who have had bleeding stomach ulcers, a history of gastrointestinal bleeding, or who have a personal or family history of bleeding disorders probably shouldn’t take aspirin to prevent their first stroke or heart attack, Perry said, because their risk of serious consequences from bleeding conditions is high. In this case, there is likely no net benefit.
Similarly, patients who are not at a high risk for cardiovascular conditions may be told not to take daily aspirin, because they weren’t at a high risk to begin with and aspirin increases their risk of bleeding. Again, there is likely no net benefit.
However, patients with a higher risk of cardiovascular conditions who don’t have a personal or family history of bleeding conditions may experience a small net benefit from daily aspirin. And there is well-documented benefit of daily aspirin in patients who have already had a heart attack or stroke.
Bleeding after injury
The other risk of daily aspirin therapy is that it is easy to bleed for a prolonged time following minor injuries. For example, Perry has had patients who have gone to the emergency room because they couldn’t stop a nosebleed. For this reason, Perry is also cautious about recommending daily aspirin for patients who work in jobs with high risk for injury, since there could be secondary health issues if they can’t stop bleeding.
Why are daily aspirin guidelines so individualized?
Because human beings vary so much. “In math, 1 + 1 is always 2. Whether you’re on the moon, under the ocean, anywhere you go — 1+1 is 2,” Perry said. "Not in medicine.”
Each person’s family history, personal health history, lifestyle and risk tolerance are different. And all of these factors need to be taken into account when making a decision about a daily medication.
“Individual discussion with your primary care provider will be critical,” Perry said, adding that the discussion should focus on the risks, benefits and alternatives of making — or not making — a choice. “Ultimately, the patient, if well-informed, makes the choice.”
Because of individual risks, Perry recommends that you wait to start any daily medications — even over-the-counter ones — until you’ve discussed them with your primary care provider.
And once a year, he says, it’s important to go over each one of your medications with your provider and provide updates on your personal and family health history over the last year.
“I've had patients who have been on certain medications for 10, 15, 20 years and nobody has re-evaluated them to see if they actually need that medication anymore,” Perry said. “It's important to follow with your primary care provider yearly so they can do a comprehensive re-evaluation, discontinue medications that you don't need, continue the ones that you absolutely need, and make sure you're not having complications.”
Are there other ways to reduce my risk of stroke or heart disease?
Experts agree: The most important way to prevent certain heart disease is by living a healthy lifestyle throughout your life. This includes eating a healthy diet, getting enough weekly exercise, stopping smoking, managing chronic conditions like diabetes, losing weight if needed, taking statins if your cholesterol is high, and reducing high blood pressure.
