Aspirin for Primary Prevention: Who Should Skip Daily Doses in 2026

For years, doctors recommended daily aspirin for primary prevention to prevent heart attacks and strokes. But that advice has changed dramatically. New research shows that for many people, the risks of taking aspirin-like serious bleeding-outweigh the benefits. So who should skip daily doses? Let’s break it down.

What Is Primary Prevention With Aspirin?

Aspirin a low-dose medication used for primary prevention of cardiovascular events for primary prevention means taking it when you don’t have heart disease yet. It’s different from secondary prevention, which is for people who already had a heart attack or stroke. The idea was that aspirin could stop the first event. But studies now show this only helps a small group. Most people don’t get enough benefit to justify the risks. For example, the U.S. Preventive Services Task Force an independent panel of experts that reviews medical evidence (USPSTF) found that for every 1,000 people taking aspirin daily, only about 0.9 fewer heart attacks happen. Meanwhile, there are 1.6 more major bleeding events. That’s more harm than good for many.

Why Guidelines Changed

Back in the 1990s, aspirin was widely recommended. But recent data flipped that. The USPSTF updated its guidelines in September 2022. Before that, they’d suggested aspirin for adults 50-59 with high heart disease risk. Now? They say USPSTF an independent panel of experts that reviews medical evidence recommends against starting aspirin for primary prevention in adults 60+. Why? Because bleeding risks grow with age. For people over 60, the risk of major bleeding (like stomach or brain bleeds) is higher than the chance of preventing a heart attack. The American Heart Association a leading organization for cardiovascular health (AHA) and American College of Cardiology a professional society for heart health professionals (ACC) also tightened their rules. They now say aspirin should only be considered for a tiny group-like those with very high heart disease risk and no bleeding risk. But even then, it’s not routine.

Who Should Skip Daily Aspirin?

Most people don’t need daily aspirin. Here’s who definitely should skip it:

• Adults 60 and older-The USPSTF says USPSTF an independent panel of experts that reviews medical evidence recommends against starting aspirin for primary prevention in this group. Bleeding risks outweigh benefits.
• People with a history of stomach ulcers-About 4% of U.S. adults have had ulcers. Aspirin can trigger dangerous bleeding in these cases.
• Those on blood thinners or NSAIDs-18.3% of adults 65+ take blood thinners like warfarin or NSAIDs like ibuprofen. Combining these with aspirin skyrockets bleeding risk.
• People with kidney disease-Kidneys help control bleeding. If they’re damaged, aspirin can make things worse.
• Anyone with uncontrolled high blood pressure-High pressure increases the chance of brain bleeds when taking aspirin.

Even if you’re younger than 60, skip aspirin if you have other bleeding risks. For example, if you’ve had a recent nosebleed or take supplements like fish oil or ginkgo biloba.

The Real Risks of Unnecessary Aspirin

Aspirin isn’t harmless. It thins your blood to prevent clots. But that same effect can cause dangerous bleeding. Here’s what happens:

• Gastrointestinal bleeding-Aspirin increases this risk by 43%. Stomach ulcers can develop silently. Symptoms? Black stools, vomiting blood, or severe abdominal pain.
• Intracranial hemorrhage-Brain bleeds rise by 38%. This is often fatal. Older adults are especially vulnerable.
• Number needed to harm-For every 267 people taking aspirin for 10 years, one will have a major bleeding event. The number needed to treat (to prevent one heart attack) is 265. So, more people are harmed than helped.

These risks aren’t theoretical. A Mayo Clinic survey found 68% of adults 65+ on aspirin reported stomach issues. Over 22% stopped taking it because of pain or heartburn.

How to Assess Your Personal Risk

Doctors use tools to calculate your heart disease risk. The most common is the Pooled Cohort Equations a risk calculator for cardiovascular disease. It estimates your 10-year risk based on age, blood pressure, cholesterol, and smoking status. If your risk is below 10%, aspirin usually isn’t recommended. For higher risk, they check bleeding risk with tools like the HAS-BLED Score a tool to assess bleeding risk. This looks at things like high blood pressure, kidney disease, or past bleeding. But here’s the problem: most primary care visits don’t use these tools properly. A 2023 study found clinicians take an average of 7.2 minutes per patient to assess aspirin eligibility. Many skip it due to time constraints.

Some newer tools exist. The PREVENT equations a refined risk assessment tool (from JAMA Internal Medicine, 2023) use blood tests and imaging for more accuracy. For example, a high coronary artery calcium (CAC) score might mean aspirin could help. But this isn’t standard yet.

What to Do If You’re Currently Taking Aspirin

Don’t stop cold turkey. If you’ve been on aspirin for years, talk to your doctor first. They’ll check your current risk level. For example:

• If you’re over 60 with no heart disease, your doctor likely recommends stopping.
• If you have a high CAC score (like over 100), they might keep you on it. A 2024 Reddit user wrote: "My cardiologist insisted I continue aspirin despite new guidelines because my calcium score puts me at high risk."
• If you have diabetes, the 2025 AHA/ACC guideline says aspirin may be considered for ages 40-70 with 10-year ASCVD risk ≥15% and no bleeding risk.

Many patients worry about stopping. A Mayo Clinic survey found 41% of adults 60+ continued aspirin despite guidelines due to "fear of stopping something that might be protecting me." But the data is clear: for most, the risks now exceed benefits.

Why Doctors Give Conflicting Advice

There’s real disagreement among experts. Dr. John Bhatt, USPSTF Vice Chair, says: "The evidence is clear that the potential harms of aspirin use for primary prevention in adults 60 and older now outweigh the potential benefits." But Dr. Maciej Banach of the Polish Lipid Association argues: "In primary-prevention patients with additional risk factors, like elevated Lp(a) or CAC score >100, aspirin should be considered." This confusion trickles down to patients. A 2023 JAMA study found 57% of patients reported "doctors giving conflicting advice." Primary care doctors are more likely to stop aspirin than cardiologists. This shows why personalized care matters-no one-size-fits-all rule applies.

What’s Next for Aspirin Guidelines?

Research continues. The NHLBI is funding the ASPRIN trial (NCT05126860), enrolling 15,000 adults with high calcium scores. Results won’t come until 2028. Meanwhile, some experts predict genetic testing will guide aspirin use. Dr. Joseph Loscalzo of Brigham and Women’s Hospital said in Nature Medicine (2024): "Within 5 years, genetic testing for aspirin response variability will become standard before initiating therapy." For now, stick to current guidelines. If you’re unsure, ask your doctor to walk you through your personal risk numbers.