For decades, a low-dose aspirin every morning was treated as a near-universal insurance policy against heart attack and stroke. That advice has quietly changed. The U.S. Preventive Services Task Force (USPSTF) now recommends against starting daily aspirin for most older adults, and three landmark trials have reshaped the conversation around who actually benefits.
Here is what current evidence shows about daily low-dose aspirin in 2026—and the persistent myths that still drive millions of unnecessary prescriptions.
How the Guidelines Changed
In April 2022, the USPSTF published a major update in JAMA, sharply narrowing the population for whom aspirin is recommended for the primary prevention of cardiovascular disease. The headline shift: adults 60 and older should not start daily aspirin to prevent a first heart attack or stroke. Adults aged 40 to 59 with a 10% or higher 10-year cardiovascular disease risk may consider it, but the decision should be individualized with a clinician (USPSTF, 2022).
This reversed earlier guidance that had endorsed aspirin for many adults in their 50s. The reason: better data showed that the bleeding risk—particularly in the gut and brain—rises sharply with age, while the cardiovascular benefit shrinks.
The American College of Cardiology and American Heart Association reached similar conclusions in their 2019 primary prevention guidelines, recommending against routine aspirin in adults over 70 and in anyone of any age at increased bleeding risk (Arnett et al., Circulation, 2019).
The Three Trials That Changed the Math
Three large randomized trials published in 2018 are the foundation for the new approach.
ASPREE: No Benefit, More Harm in Healthy Older Adults
The Aspirin in Reducing Events in the Elderly (ASPREE) trial randomized more than 19,000 community-dwelling adults aged 70 and older (65 and older for Black and Hispanic participants in the United States) to 100 mg of aspirin or placebo. After a median follow-up of nearly five years, aspirin did not lower the rate of cardiovascular events, but it significantly increased major hemorrhage—including gastrointestinal and intracranial bleeding. Researchers also reported a small but unexpected increase in all-cause mortality, largely driven by cancer deaths (McNeil et al., New England Journal of Medicine, 2018).
ARRIVE: No Benefit in Moderate-Risk Adults
The ARRIVE trial enrolled more than 12,500 adults at moderate cardiovascular risk and found that 100 mg of aspirin did not significantly reduce the primary composite endpoint of cardiovascular events compared with placebo. Gastrointestinal bleeding was more than twice as common in the aspirin group (Gaziano et al., The Lancet, 2018).
ASCEND: A Modest, Offset Benefit in Diabetes
In adults with diabetes but no known cardiovascular disease, the ASCEND trial showed that 100 mg of aspirin reduced serious vascular events by about 12%. However, the benefit was almost entirely offset by a 29% increase in major bleeding events (ASCEND Study Collaborative Group, New England Journal of Medicine, 2018).
Together, the trials make the same point: in people who have not had a heart attack or stroke, the bleeding cost of aspirin often cancels the cardiovascular gain.
Primary vs. Secondary Prevention—A Critical Distinction
The new guidance applies only to primary prevention: people who have not had a heart attack, ischemic stroke, stent, or bypass.
For secondary prevention—people who already have established cardiovascular disease—the evidence still strongly supports daily low-dose aspirin in most cases. A landmark meta-analysis from the Antithrombotic Trialists’ Collaboration in The Lancet found aspirin produced a roughly 20% reduction in serious vascular events in patients with prior cardiovascular disease, a benefit that clearly outweighs the bleeding risk for most (ATT Collaboration, 2009).
Anyone currently taking aspirin after a cardiovascular event should not stop without medical advice. Abrupt discontinuation has been linked to a rebound increase in events.
Common Myths That Persist
Myth: “Aspirin is harmless—it’s just a painkiller.”
Research suggests low-dose aspirin roughly doubles the risk of major gastrointestinal bleeding and modestly increases the risk of hemorrhagic stroke. Bleeding risk rises with age, kidney disease, prior ulcers, and combined use with NSAIDs, blood thinners, or alcohol.
Myth: “Everyone over 50 should take a baby aspirin.”
Current USPSTF and AHA guidance no longer endorses this. For most adults without prior cardiovascular disease, the harms now appear to match or exceed the benefits.
Myth: “I’ll take one at the first sign of a heart attack and be fine.”
Chewing a regular-strength uncoated aspirin during a suspected heart attack can help, but only while emergency medical services are on the way. Calling 911 is the priority. Aspirin alone is not a substitute for emergency treatment.
Myth: “Aspirin prevents cancer, so I should keep taking it.”
Some studies indicate aspirin may reduce colorectal cancer risk over many years of use, but the USPSTF concluded in 2022 that the evidence was not strong enough to recommend aspirin specifically for cancer prevention. The ASPREE follow-up actually raised concerns about cancer mortality in older adults starting aspirin late in life.
Who May Still Benefit
According to the current evidence base, daily low-dose aspirin remains reasonable for:
- Adults who have had a prior heart attack, ischemic stroke, stent, or coronary bypass (secondary prevention).
- Some adults aged 40 to 59 with a calculated 10-year cardiovascular risk of 10% or higher and low bleeding risk—after a shared decision with their clinician.
- Specific high-risk situations identified by a cardiologist, such as certain peripheral artery disease cases.
It is generally not recommended to start in:
- Healthy adults 60 and older with no history of cardiovascular disease.
- People with active ulcers, recent GI bleeding, or bleeding disorders.
- People already on anticoagulants without a specific cardiology indication.
What to Do Next
If you are taking daily aspirin, do not stop on your own—especially if you have a history of cardiovascular events. Instead, bring it up at your next visit. Ask your clinician to calculate your 10-year cardiovascular risk (using the ACC/AHA risk calculator), review your bleeding risk factors, and decide together whether aspirin still fits.
For most healthy adults today, the better investment in heart health is the boring, durable kind: blood pressure control, LDL cholesterol management, not smoking, weekly aerobic activity, and a Mediterranean-style diet. Studies indicate these levers move cardiovascular risk far more than a daily aspirin ever did.
Disclosure: This content is for informational purposes only and is not medical advice. Always consult a qualified healthcare provider before making changes to your health regimen.