Aspirin Therapy for Heart Disease Prevention: Who Should Take It in 2026?

For decades, taking a daily low-dose aspirin was common advice for anyone worried about heart disease. If your parent had a heart attack, your doctor might have handed you a bottle of baby aspirin with a nod and said, "Better safe than sorry." But that’s not the story anymore. As of 2026, the science has turned a corner - and what once felt like a simple, harmless habit could now be doing more harm than good.

Why the Rules Changed

Aspirin works by thinning the blood. It stops platelets from clumping together, which can block arteries and trigger heart attacks or strokes. For people who’ve already had a heart attack, stroke, or stent placed, aspirin is still a lifesaver. That’s called secondary prevention, and it’s not up for debate.

But for people without any history of heart disease - the group called primary prevention - the balance has flipped. Large, high-quality studies from 2018 onward, like ASPREE, ASCEND, and ARRIVE, showed something startling: while aspirin slightly lowers the risk of a first heart attack, it also increases the chance of dangerous bleeding - in the stomach, brain, or elsewhere - by about 43%. For many, the bleeding risk outweighs the benefit.

The U.S. Preventive Services Task Force (USPSTF) updated its guidelines in 2022, and most major health groups now agree: don’t start aspirin for heart disease prevention if you’re over 60. The older you are, the higher your bleeding risk. And with better control of blood pressure, cholesterol, and diabetes thanks to statins and lifestyle changes, the extra protection aspirin offers has shrunk to almost nothing.

Who Might Still Benefit

There’s a narrow group where aspirin might still make sense - but only after careful thought.

• Adults aged 40 to 59 with a 10% or higher 10-year risk of heart disease, calculated using the ACC/AHA pooled cohort equation.
• People with diabetes who are over 40 and have at least one other risk factor - like high blood pressure, smoking, or kidney disease.
• Those with familial hypercholesterolemia and a very high lifetime risk, even if they’re younger.

The key here is individualized risk. It’s not about age alone. It’s about your full picture: cholesterol levels, blood pressure, whether you smoke, if you have diabetes, and your history of bleeding. A 55-year-old with type 2 diabetes, high LDL, and a family history of early heart disease might still benefit. A 58-year-old with normal numbers and no other risks? Probably not.

How Risk Is Measured

Doctors don’t guess. They calculate. The standard tool is the ACC/AHA pooled cohort equation. It uses seven inputs:

• Age
• Sex
• Race
• Total cholesterol
• HDL (good) cholesterol
• Systolic blood pressure (and whether you’re on treatment)
• Diabetes status
• Smoking status

If your calculated 10-year risk is 7.5% to 10% or higher, that’s the threshold where aspirin might be considered. Below that? The chance of benefit is too small to justify the risk.

Bleeding risk is checked with the HAS-BLED score. Points are added for:

• Hypertension
• Abnormal kidney or liver function
• History of stroke
• Previous bleeding
• Unstable INR (if on blood thinners)
• Age over 65
• Drinking 3+ alcoholic drinks daily

A score of 3 or higher means high bleeding risk - and aspirin is usually a no-go.

What About Family History?

This is where confusion runs deep. Many people keep taking aspirin because their dad had a heart attack at 55. But genetics alone don’t override current risk. If you’re 65, have no high blood pressure, no diabetes, don’t smoke, and your cholesterol is fine - your family history doesn’t change the math. Your risk today is what matters.

In fact, a 2019 study in Circulation found that nearly 7 million Americans over 60 take aspirin for prevention without a doctor’s recommendation - mostly because of family history. That’s outdated thinking. You’re not your father. Your body, your lifestyle, your lab results - those are your real indicators.

How Much Aspirin? And What Kind?

If your doctor says it’s right for you, the dose is 75 to 100 mg per day. That’s one low-dose or "baby" aspirin. Don’t take more. Higher doses don’t offer more protection - they only increase bleeding risk.

Regular aspirin (325 mg) is not recommended for prevention. It’s for pain or fever. Stick to the low-dose version if prescribed.

And don’t assume enteric-coated aspirin is safer for your stomach. Studies show it doesn’t reduce bleeding risk significantly. The real issue isn’t the coating - it’s the drug itself.

Aspirin vs. Statins

Here’s the big shift: statins are now the first line for heart disease prevention. They lower LDL cholesterol - the main driver of artery-clogging plaque - by 30% to 50%. Aspirin reduces heart attack risk by only about 10% to 15%.

If you’re at risk, you’re far more likely to benefit from a statin than from aspirin. In fact, many people who take aspirin for prevention don’t even take a statin - which means they’re missing the most effective tool.

Think of it this way: aspirin is like putting a bandage on a leaky pipe. Statins are fixing the pipe itself.

What If You’re Already Taking It?

If you’ve been on aspirin for years and have no heart disease, don’t stop cold turkey. Talk to your doctor. Stopping suddenly can cause rebound clotting in rare cases.

Ask these questions:

• What was my 10-year heart disease risk when I started?
• Has my risk changed since then?
• Do I have any bleeding risk factors now?
• Am I on any other blood thinners or NSAIDs like ibuprofen?

If you’re over 60, have no heart disease, and have no clear reason to continue, your doctor may suggest stopping. The data shows the harm increases with age - and the benefit disappears.

Real Stories, Real Risks

One woman in her early 60s took aspirin daily for 15 years because her mother had a stroke. She had no symptoms, no high blood pressure, normal cholesterol. One morning, she woke up with black, tarry stools. She ended up in the ER with a bleeding ulcer. She needed a blood transfusion. She stopped aspirin. No more bleeding.

Another man, 58, with diabetes and high blood pressure, asked his doctor about aspirin. His 10-year risk was 18%. His HAS-BLED score was 1. His doctor said yes. He’s been on it for two years. No bleeding. No heart attack. That’s the sweet spot: high risk, low bleeding chance.

But too many people fall into the middle - not high enough risk to benefit, not low enough risk to feel safe. That’s where the confusion lives.

What You Should Do Now

Here’s your action plan:

1. If you’re under 40: Don’t take aspirin for prevention. Your risk is too low.
2. If you’re 40-59: Ask your doctor to calculate your 10-year heart disease risk. If it’s below 7.5%, skip aspirin. If it’s 10% or higher, talk about whether aspirin makes sense - especially if you have diabetes or other risk factors.
3. If you’re 60 or older: Don’t start aspirin. If you’re already taking it, talk to your doctor about stopping.
4. If you have heart disease, a stent, or a history of stroke: Keep taking it - unless your doctor says otherwise.
5. Never take aspirin with alcohol regularly. Never take it with NSAIDs like ibuprofen unless directed.

And if you’re unsure? Get your numbers checked. A simple blood test, blood pressure reading, and cholesterol panel can tell you more than any anecdote or family story ever could.

The Bottom Line

Aspirin isn’t a magic pill. It’s a tool - and like any tool, it’s only useful in the right hands. For most people today, it’s no longer the right tool for preventing a first heart attack. Statins, blood pressure control, exercise, and quitting smoking do far more with less risk.

The days of blanket aspirin recommendations are over. What’s left is a smarter, more personal approach. If you’re thinking about aspirin for heart health, don’t rely on habit. Don’t follow your neighbor’s routine. Let your numbers - not your fears - guide you.