Daily Aspirin: Is It Still a Smart Way to Protect Your Heart?

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For decades, low-dose aspirin was a regular recommendation to reduce the risk of heart attacks and strokes. But recent research is reshaping that advice. Dr. Michael Miedema, MD, MPH, director of the Nolan Family Center for Cardiovascular Health at Minneapolis Heart Institute Foundation shares the latest recommendations, and they might surprise you.

How is aspirin helpful for your heart?

Let’s start by how a heart attack actually occurs. A heart attack happens when the coronary blood vessels cannot deliver oxygen to the heart due to a blockage. Many people attribute that blockage to a slow buildup of plaque inside the coronary arteries. However, this blockage typically happens when that plaque ruptures leading to the formation of a blood clot that - if large enough- blocks the blood flow and results in a heart attack.

Aspirin has the potential to reduce the size of the blood clot, thereby preventing a heart attack. Because strokes can happen similarly, aspirin can help reduce the risk of stroke as well.

Studying aspirin’s effectiveness

Randomized controlled studies – trials that divide the study population into two groups and randomly assign them to receive aspirin or a placebo (a treatment that looks real but doesn’t contain any active ingredients) – offer answers about how effective aspirin is to prevent heart attack and stroke. Trials that were conducted in the 1980s and 1990s showed significant reductions in risk for heart attack and stroke among individuals taking a daily aspirin. While more recent studies show little to no benefit for those without cardiovascular disease. That’s where the confusion comes in.

Explaining the shift

Many attribute this shift to preventive interventions for heart disease that have been developed in the last several decades. Better treatments for high cholesterol and high blood pressure, and less smoking in the general population, have added up to lower the risk of heart attack. As a result, today’s patients now see a smaller benefit from aspirin. Additionally, more recent studies show taking a daily aspirin comes with a higher risk of gastrointestinal (or stomach) bleeding.

Recent aspirin recommendations

These results have led to new aspirin recommendations related to cardiovascular disease. For anyone with a history of cardiovascular disease, the recommendations have not changed—you should still take a daily 81mg dose of baby aspirin. However, if you have a low risk of cardiovascular disease, a daily aspirin is no longer recommended. The same holds true if you have a high bleeding risk or are over age 70 without prior cardiovascular disease. In these cases, the risk of bleeding outweighs any benefit that aspirin may give.

Adults age 40-79 years with a high risk of cardiovascular disease and a low risk for bleeding may still benefit from a daily aspirin. Talk with your primary care provider or cardiologist if taking a daily aspirin is right for you.

More information on aspirin and heart health is available by viewing the Should I Take an Aspirin to Prevent Heart Disease? in the MHIF Heart Disease Prevention Video Series.