Daily Aspirin to Prevent a First Heart Attack or Stroke: What Guidance Says

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This guide explains one specific question: whether an adult who has never had a heart attack or stroke should start taking low-dose aspirin to prevent a first cardiovascular event. That is different from aspirin prescribed after a heart attack, stroke, or certain procedures.

What current U.S. guidance says

The U.S. Preventive Services Task Force (USPSTF) says adults ages 40–59 who have an estimated 10-year cardiovascular risk of at least 10% may make an individual decision with a clinician about starting low-dose aspirin for primary prevention. The expected net benefit is small. The USPSTF recommends against starting aspirin for primary prevention in adults 60 and older. This recommendation applies to people without known cardiovascular disease and who are not at increased risk of bleeding.

These recommendations concern starting aspirin to prevent a first event. They are not instructions for people already taking aspirin after a heart attack or stroke, or for another medical reason. Do not stop or change prescribed aspirin without discussing it with the clinician who recommended it.

Why the decision is individualized

Aspirin can reduce blood clotting, which may help prevent some cardiovascular events. The same effect can cause harm, including bleeding in the stomach or intestines and, less commonly, bleeding in the brain. Age, medical history, other medicines, bleeding risk, and personal cardiovascular risk all affect the balance. A general article cannot calculate that balance for an individual.

Questions to take to an appointment

  • Am I asking about prevention of a first event, or have I already had cardiovascular disease?
  • What is my estimated 10-year cardiovascular risk, and how was it calculated?
  • What factors increase my risk of bleeding, including medicines or a history of ulcers?
  • What other prevention steps or treatments fit my situation?
  • If I already take aspirin, what was the reason it was prescribed and should that plan change?

Keep prevention practical

Heart-health planning can also include discussing blood pressure, cholesterol, diabetes risk, tobacco use, diet, and physical activity with a healthcare professional. The best plan depends on your health history and preferences. Do not use a news headline, online checklist, or another person's experience to start or stop a medicine.

Source and scope

The summary above reflects the USPSTF's U.S. recommendation published in April 2022. Guidelines can differ by country and may be updated. Read the full USPSTF recommendation on aspirin to prevent cardiovascular disease and discuss your own circumstances with a qualified healthcare professional.

This article is general educational information and is not medical advice. It does not replace a clinician's instructions.

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