May 5, 2025·6 min read

Low Dose Aspirin for Heart Health: Who Should Take It?

Daily low-dose aspirin was once standard advice for heart disease prevention. Current guidelines are more selective. Here's what you need to know.

For decades, low-dose aspirin (81mg daily) was widely recommended for cardiovascular prevention. Recent guidelines from the U.S. Preventive Services Task Force (USPSTF) have significantly changed this recommendation.

Current Guidelines (2022)

The USPSTF now recommends:

**Against** initiating low-dose aspirin for primary prevention of cardiovascular disease (CVD) in adults **60 and older**

**Against** initiating low-dose aspirin for primary prevention in adults **40-59** who do not have a 10% or greater 10-year CVD risk

The key word is "initiating" — if your doctor already has you on aspirin, do not stop without consulting them.

Who Still Benefits

Low-dose aspirin remains recommended for:

**Secondary prevention**: people who have already had a heart attack or stroke

Patients with established coronary artery disease

Those with certain high-risk conditions as determined by their cardiologist

Why the Change?

The concern is bleeding risk. Aspirin's anti-platelet effect that prevents clots also increases the risk of gastrointestinal and intracranial bleeding. In people without a history of cardiovascular events, the bleeding risk often outweighs the cardiovascular benefit.

Enteric-Coated vs Regular Aspirin

Enteric-coated aspirin is designed to dissolve in the small intestine rather than the stomach, potentially reducing direct stomach irritation. However, studies show it does not significantly reduce the risk of serious GI bleeding compared to regular aspirin.

Bottom Line

Do not start or stop low-dose aspirin therapy without speaking to your doctor. The decision should be individualized based on your cardiovascular risk factors, bleeding risk, and medical history.

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