For most healthy adults, taking aspirin every day is no longer recommended. Guidelines shifted significantly in 2022, and the answer now depends on your age, your heart disease history, and your personal bleeding risk. If you’ve never had a heart attack or stroke, daily aspirin carries real downsides that often outweigh the benefits.
Why the Advice Has Changed
For decades, millions of people took a daily low-dose aspirin (typically 81 mg, sometimes called “baby aspirin”) to prevent a first heart attack or stroke. That practice, known as primary prevention, made intuitive sense: aspirin blocks a chemical that helps blood clots form, so it should reduce the chance of a clot blocking an artery in the heart or brain.
But large clinical trials eventually showed the math doesn’t work out for most people. The small reduction in heart attacks comes with a meaningful increase in dangerous bleeding, particularly in the stomach and intestines. In 2022, the U.S. Preventive Services Task Force issued updated recommendations that drew a clear line: adults 60 and older should not start daily aspirin for primary prevention. The task force concluded with moderate certainty that starting aspirin at 60 or older provides no net benefit.
For adults 40 to 59 with an elevated risk of heart disease (a 10-year cardiovascular risk of 10% or higher), the task force called the net benefit “small” and said the decision should be individualized. People in this group who don’t have risk factors for bleeding and who are willing to commit to daily use are the most likely to see a benefit. For everyone else, the risks generally aren’t worth it.
When Daily Aspirin Is Still Important
The calculus is entirely different if you’ve already had a heart attack, stroke, or been diagnosed with cardiovascular disease. This is called secondary prevention, and the evidence here remains strong. Current guidelines recommend 75 to 100 mg of aspirin daily for these patients, and the standard dose in the U.S. is 81 mg. In this group, aspirin meaningfully reduces the chance of another cardiovascular event, and the benefits clearly outweigh the bleeding risk for most people.
If you’ve had stents placed or undergone other heart procedures, aspirin is typically part of an ongoing treatment plan. Stopping it without medical guidance can be dangerous, which is covered further below.
The Bleeding Risk Is Real
Aspirin’s main danger is bleeding, especially in the gastrointestinal tract and, less commonly, inside the skull. Even at low doses (100 mg or less), aspirin increases the risk of major GI bleeding by about 58%, according to a systematic review conducted for the task force. In practical terms, that translates to roughly 1.4 extra major GI bleeding events per 1,000 people per year of aspirin use. That may sound small, but over years of daily use, the cumulative risk adds up.
Bleeding inside the skull (intracranial hemorrhage) is rarer but more serious. A large cohort study of low-dose aspirin users found an incidence of about 0.08 per 100 person-years, meaning roughly 8 events per 10,000 people per year. The rate was slightly higher among people taking aspirin for secondary prevention (0.09 per 100 person-years) compared to primary prevention (0.07 per 100 person-years).
Several factors raise your bleeding risk further: being over 70, having a history of stomach ulcers, taking blood thinners or corticosteroids, heavy alcohol use, and uncontrolled high blood pressure. If any of these apply to you, daily aspirin becomes a harder sell for prevention purposes.
The Colorectal Cancer Connection
One area where aspirin shows genuine promise is colorectal cancer prevention, though this wasn’t enough to change the overall recommendations. Long-term aspirin use (six years or more) has been linked to a 19% decreased risk of colorectal cancer and a 15% decreased risk of any gastrointestinal cancer in large cohort studies led by researchers at Harvard. Aspirin also reduces the formation of colon polyps, which can be precursors to cancer.
The effect is especially pronounced in people with Lynch syndrome, a hereditary condition that dramatically raises colorectal cancer risk. In the CAPP2 trial, participants with Lynch syndrome who took daily aspirin had a 63% reduction in colorectal cancer risk compared to placebo. Research also suggests aspirin may complement regular colonoscopy screening by lowering the chance of cancers developing between screening intervals. Still, these cancer benefits take years to emerge and don’t apply equally to everyone, so they aren’t typically a standalone reason to start daily aspirin.
Aspirin and Common Pain Relievers
If you take daily aspirin for heart protection, be careful with ibuprofen (Advil, Motrin). The FDA has warned that ibuprofen can interfere with aspirin’s ability to prevent clots when the two are taken at the same time. The timing of each dose matters. If you need both medications, spacing them apart can help preserve aspirin’s protective effect, but the specific timing depends on your situation.
Acetaminophen (Tylenol) does not have this interaction and is generally a safer choice for occasional pain relief if you’re on daily aspirin.
Why You Shouldn’t Stop Abruptly
If you’ve been taking aspirin daily and want to stop, don’t do it cold turkey. A large Swedish study of more than 600,000 aspirin users found that people who discontinued aspirin had a 37% higher rate of cardiovascular events compared to those who continued. The risk increase appeared shortly after stopping and didn’t fade over time.
The effect was most dramatic in people using aspirin for secondary prevention: discontinuation was associated with a 46% higher event rate, translating to one additional cardiovascular event per year for every 36 patients who stopped. Even among people using aspirin for primary prevention, stopping was linked to a 28% higher event rate.
Researchers believe this happens partly because of a rebound effect. When aspirin is removed, levels of the clotting chemical it was suppressing can surge above normal, temporarily creating an even higher clot risk than before you started taking aspirin in the first place. This is why any decision to stop should be gradual and planned.
How Aspirin Works in the Body
Aspirin permanently disables an enzyme in platelets (the blood cells responsible for clotting) that produces a chemical called thromboxane, which normally triggers platelets to clump together. Because platelets can’t repair themselves, a single dose of aspirin knocks out that clotting ability for the entire 7-to-10 day lifespan of the platelet. This is why even low doses are effective and why the effects linger after you stop taking it.
In people with metabolic conditions like obesity or diabetes, platelet turnover tends to be faster. The body produces new, fully functional platelets more quickly, which can partially blunt aspirin’s effect between doses. This is one reason some people on daily aspirin don’t get the full expected benefit.
Who Might Still Benefit
Daily aspirin remains clearly appropriate for people with established cardiovascular disease. For everyone else, the group most likely to benefit is adults between 40 and 59 who have a meaningfully elevated heart disease risk (10% or greater over 10 years, which your doctor can calculate using standard risk tools), no history of bleeding problems, and no other factors that increase bleeding risk. Even in this group, the expected benefit is modest.
If you’re 60 or older and have never had a heart attack or stroke, starting daily aspirin is now specifically recommended against by the task force. If you’re already taking it, that’s a conversation worth having at your next appointment, keeping in mind that stopping should be done deliberately rather than on your own.