The Daily Aspirin Question: Why the Advice Changed for Seniors

Here is a habit worth a second look. For years, a daily low-dose aspirin was a common way to try to head off a first heart attack or stroke. Then, in 2022, the U.S. Preventive Services Task Force, a national panel of prevention experts, recommended against starting daily low-dose aspirin for that purpose at age 60 or older.

Plenty of people are still taking it. According to reports on a study published in 2024 in the Annals of Internal Medicine, about 3 in 10 adults 60 and older without known cardiovascular disease said in 2021 that they took aspirin to prevent a heart attack or stroke. Some of that use may be right for the person taking it. If you’re one of them, it’s worth a fresh conversation with your doctor.

Two Very Different Reasons to Take Aspirin

The 2022 change applies to only one of them.

• Preventing a first heart attack or stroke. Doctors call this primary prevention. It’s for people with no known heart or blood vessel disease, no signs or symptoms of it, and no other condition for which aspirin was prescribed. This is the use that changed.
• Preventing another one. If you’ve already had a heart attack or stroke, you have diagnosed heart disease, or your doctor prescribed aspirin for another condition, the 2022 recommendation doesn’t apply to you. MedlinePlus, from the National Institutes of Health, says aspirin therapy is very helpful for people with coronary artery disease or a history of stroke.

Why the Advice Changed

Aspirin helps prevent blood clots from forming in your arteries. That’s how it may help lower the risk of a heart attack or stroke.

The trade-off is bleeding. The task force notes that aspirin raises the risk of bleeding in the stomach and digestive tract, bleeding inside the skull, and a type of stroke caused by bleeding in the brain. It describes these harms as small overall, but larger in older age groups. Both heart risk and bleeding risk rise with age.

After weighing the evidence, the task force concluded with moderate certainty that starting aspirin at 60 or older to prevent a first heart attack or stroke has no net benefit. In other words, the expected good doesn’t outweigh the expected harm.

One of the studies behind the change was a trial called ASPREE, published in the New England Journal of Medicine in 2018 and funded by the National Institute on Aging and others. It followed 19,114 healthy people in the U.S. and Australia, aged 70 or older (65 or older for Black and Hispanic participants in the U.S.), who had no cardiovascular disease, dementia, or disability. Participants were assigned to take either 100 mg of aspirin a day or a placebo and were followed for a median of about 4.7 years.

In this trial:

• Aspirin did not significantly lower the risk of cardiovascular events like heart attacks and strokes.
• Major bleeding was more common: 3.8% of the aspirin group compared with 2.8% of the placebo group.
• Aspirin did not help people live longer free of dementia or disability.

If You Started Years Ago

The task force now says the decision to start aspirin in your 40s or 50s, for people at higher heart risk, should be an individual one. For people who did start, it notes that the benefits get smaller with age as bleeding risk grows. It adds that modeling data suggest it may be reasonable to consider stopping around age 75.

That is a conversation to have with your doctor, who knows your full history.

Before You Change Anything

• Don’t stop on your own. The task force says people taking aspirin should not stop without consulting their clinician. MedlinePlus agrees, and adds that if you’ve had a heart attack or a stent placed, you should ask your heart doctor whether it’s OK to stop.
• Know your bleeding risks. The task force lists a history of stomach ulcers, liver disease, diabetes, smoking, and high blood pressure among the factors that raise bleeding risk, along with medicines like NSAIDs, steroids, and blood thinners.
• Check for hidden aspirin. MedlinePlus notes that aspirin also comes combined with other medicines, including some pain relievers and cough and cold products. Read the package label.
• Be careful with ibuprofen. If you take aspirin regularly to prevent a heart attack or stroke, MedlinePlus advises talking to your doctor before taking ibuprofen for pain or fever.
• Tell your surgeon and dentist. MedlinePlus advises letting them know you take aspirin before any surgery, including dental surgery.

Questions Worth Asking at Your Next Visit

• Why am I taking aspirin: to prevent a first heart attack or stroke, or because of a condition I already have?
• Do the benefits still outweigh the bleeding risk for me?
• Do any of my other medicines raise my bleeding risk?
• If I should stop, is it safe to stop now?

The Bottom Line

The advice on daily aspirin changed because the evidence did. For people 60 and older with no known heart or blood vessel disease and no other reason to take aspirin, the task force now recommends against starting it.