Should You Take Aspirin for your Heart? The Answer Keeps Changing

One of the most confusing questions in modern medicine has been: “aspirin for your heart?” This inexpensive old drug has been praised, dismissed, recommended, restricted and re-evaluated more times than we can count. A study in JAMA Network Open (June 4, 2026) adds another twist to the aspirin story.

Researchers wanted to know whether all the negative messaging about aspirin for primary prevention had spilled over into secondary prevention. That distinction matters.

Primary prevention means taking aspirin to prevent a first heart attack or stroke. Secondary prevention means taking aspirin after someone has already been diagnosed with cardiovascular disease, such as a prior heart attack, stroke or peripheral artery disease.

Aspirin For Your Heart

The investigators analyzed survey data collected in 2015, 2017 and 2019 to 2020 from adults with atherosclerotic cardiovascular disease. Their finding may surprise some aspirin critics: aspirin use for secondary prevention did not decline, despite increasingly negative messages about aspirin for primary prevention. Among people who had stopped taking aspirin, only 1.8 percent blamed negative messaging. Most stopped because their physician discouraged it.

That last point is crucial. The researchers found that people who had discussed aspirin with a physician were about half as likely to stop taking it. Their conclusion was not “everyone should take aspirin.” It was that doctor-patient communication remains essential when guidelines change and public health messages become confusing.

That brings us back to the question we have been asking for years: Should you take aspirin for your heart?

Aspirin for Your Heart Has Been a Roller Coaster Ride

Aspirin is well over 100 years old, but scientists are still trying to figure out who should use it to prevent heart attacks and strokes.

The US Preventive Services Task Force (USPSTF) was created in 1984. It is an independent panel of national experts in prevention and evidence-based medicine. Sounds great. But when it comes to its position on aspirin for your heart, the USPSTF trajectory has been anything but straightforward.

The Physicians’ Health Study was published in the New England Journal of Medicine on July 20, 1989. It involved 22,071 healthy male doctors. They were randomized to take either one regular-strength aspirin tablet, 325 mg, every other day or placebo. The average follow-up time was 60.2 months.

The researchers reported a 44 percent reduction in the risk of heart attack among men taking aspirin. For comparison, the maker of Lipitor (atorvastatin) was happy to advertise that its cholesterol-lowering drug reduced the risk of heart attack by 36 percent. At last count, nearly 30 million people take atorvastatin daily. It is the most prescribed drug in America. Some physicians believe that not prescribing atorvastatin might be considered medical malpractice.

There was a follow-up analysis of physicians in this group who had chronic stable angina. In plain English, that means chest pain on exertion or after emotional stress. In this higher-risk group of doctors, there was an 87 percent reduction in heart attacks among the men randomized to take aspirin (Annals of Internal Medicine, May 15, 1991).

As far as we can tell, these men had not yet had a cardiovascular event (heart attack or stroke). So, for them, aspirin treatment was considered primary prevention even though some did have “chronic stable angina.”

There was one more intriguing detail from the trial:

“The benefit was present at all levels of cholesterol, but appeared greatest at low levels.”

The authors concluded that alternate-day aspirin therapy greatly reduced the risk for a first heart attack among patients with chronic stable angina, a group already at high risk for cardiovascular death.

Since the Physicians’ Health Study, there have been many more randomized controlled trials of aspirin. The results have been conflicting. The recommendations have bounced around like a tennis ball on a bad court. (I have played tennis on uneven courts and I can assure you that it can be nerve wracking to try to hit balls bouncing in unpredictable ways).

Aspirin for Your Heart: Yes, Maybe, No

The USPSTF issued its first Guide to Clinical Preventive Services in 1989. That initial monograph included a recommendation to consider aspirin prophylaxis for primary cardiovascular prevention in men 40 years or older with coronary risk factors and low bleeding risk (JAMA, April 26, 2022).

In 1996, the USPSTF changed its mind about aspirin for your heart. The experts concluded that the pros and cons were too close to give the drug its blessing for heart attack prevention.

In 2002, the USPSTF modified its stance yet again after three more studies were published. This time the task force suggested that doctors discuss aspirin use to prevent heart attacks in high-risk patients after consulting risk calculators.

An editorial in JAMA, April 26, 2022 added additional history:

“In 2009, the USPSTF went further. It strongly and specifically recommended aspirin prophylaxis for a broad range of adults: men ages 45 to 79 and women ages 55 to 79, depending on estimated 10-year risk for heart attack, stroke and gastrointestinal bleeding.”

Then came another turn in the road according to the JAMA editorial:

In April 2016, the USPSTF put out a new recommendation regarding aspirin. These experts suggested that low-dose aspirin use could prevent heart attacks, strokes and colorectal cancer. The benefits were “modest,” and there was a risk of bleeding. The task force suggested that only people with a high risk of heart disease over the next 10 years and no increased risk for hemorrhage should consider aspirin prevention.

Then a study in  The Lancet (July 12, 2018) analyzed data from 10 trials. The authors concluded that low-dose aspirin might be less effective for people weighing more than 154 pounds.

The following year a meta-analysis published in JAMA (Jan. 22, 2019) reviewed the results of 13 placebo-controlled trials involving more than 160,000 participants. The authors found that people taking aspirin were significantly less likely to suffer heart attacks, strokes or death from cardiovascular causes, but they were also more likely to experience major bleeding. The absolute cardiovascular risk reduction was 0.41 percent, with a number needed to treat of 241. The absolute increase in major bleeding was 0.47 percent, with a number needed to harm (NNH) of 210.

The number needed to treat of 241 would mean that 1 person out of 241 would experience benefit. The number needed to harm means that if 210 people took a drug for some hoped-for benefit, 1 would experience harm. This puts the benefit/harm ratio neck and neck.

That is the aspirin dilemma in a nutshell. The benefit was real, but modest. The bleeding risk was also real, but modest. The two were surprisingly close.

Another Adjustment in Recommendations About Aspirin for Your Heart

On April 26, 2022, the USPSTF reviewed the evidence and concluded (JAMA, April 26, 2022):

“Low-dose aspirin was associated with small absolute risk reductions in major cardiovascular disease events and small absolute increases in major bleeding.”

Another Adjustment in the Latest USPSTF Recommendations About Aspirin for Your Heart:

The task force then made the following recommendation (JAMA, April 26, 2022):

“The decision to initiate low-dose aspirin use for the primary prevention of CVD [cardiovascular disease] in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit. The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older.”

What Does That Mean?

After reviewing all the studies and modeling the benefits and risks, the task force recommends that doctors consult with patients between 40 and 59 years old. For those with a 10 percent chance of cardiovascular disease over the next 10 years, low-dose aspirin may make sense.

But only people unlikely to have a bleeding problem should try this, since aspirin can also increase that risk. Moreover, the task force suggests that aspirin to prevent an initial heart attack does not make sense for people over 60. The benefit for the younger age group was modest.

That is where many patients get confused. They hear “don’t take aspirin” and assume that applies to everyone. It does not.

The new JAMA Network Open study (June 4, 2026) suggests that most people taking aspirin for secondary prevention were not scared off by media messages about aspirin for primary prevention. That is reassuring. But it also reinforces the need for a clear conversation with a clinician.

Aspirin for Your Heart? Should You or Shouldn’t You?

We cannot answer that question on a global basis. Each individual will need to discuss this question with a primary care provider or cardiologist.

That said, let’s drill down on the data. The 2019 JAMA study did an excellent job presenting absolute benefit and risk data. We only wish more research were presented this way.

The absolute risk reduction with aspirin was small: about 0.4 percent. How did the researchers come up with that number? Please pay careful attention. This gets complicated.

The investigators analyzed the data for primary outcomes. That means death from cardiovascular causes, nonfatal heart attacks and nonfatal strokes. There were 3,072 such events in the no-aspirin group and 2,911 events in the aspirin-taking group. That was an 11 percent relative reduction in events.

But in absolute terms, 241 people would have needed to take aspirin to prevent one cardiovascular event.

Here’s another way to think of this benefit. There were 61.4 events per 10,000 participant-years in the no-aspirin group. There were 57.1 events per 10,000 participant-years in the aspirin group. That was a statistically significant reduction in cardiovascular events, but as you can see, not a dramatic one.

How Dangerous Is Aspirin for Your Heart?

The analysis also considered whether people taking aspirin were more likely to experience major bleeding. They were, although here too the difference was small: about 0.5 percent.

There were 23.1 major bleeding events per 10,000 participant-years among aspirin-taking people and 16.4 serious bleeding events per 10,000 participant-years among those not taking aspirin. The number needed to harm was 210.

That does not mean aspirin is wildly dangerous for everyone. It means that bleeding is a real risk and must be taken seriously. People with a history of bleeding ulcers, recent bleeding, clotting problems, kidney disease, uncontrolled high blood pressure or those taking blood thinners, corticosteroids, SSRI antidepressants or NSAIDs may face a different risk-benefit equation.

That is why the “one-size-fits-all” aspirin recommendation has gone out of style.

Making Decisions About Aspirin for Your Heart

The relatively small benefits and risks make a decision to use aspirin more complicated, especially for people without diagnosed heart disease.

The authors of the 2019 JAMA study concluded that the decision to use aspirin for primary prevention may need to be made on an individual basis, accounting for the patient’s risk of bleeding and views on the balance of risk vs benefit.

That sounds sensible. It also sounds like something that rarely happens in a 12-minute office visit.

The bottom line seems to be this: if your risk of a serious cardiovascular event is pretty high, low-dose aspirin could be modestly beneficial. If your risk of bleeding is high, the equation shifts against aspirin. Sorry. We warned you this was complicated.

When it comes to aspirin for your heart, there are no easy answers.

Aspirin for Your Heart Is Not the Same as Aspirin After a Heart Attack

This is where the new JAMA Network Open study is useful. It reminds us that aspirin messaging has become muddy.

There is a big difference between someone who has never had a heart attack and someone who has already had one. There is a big difference between someone taking aspirin “just in case” and someone taking it after a stent, bypass surgery, stroke, transient ischemic attack or diagnosis of peripheral artery disease.

The JAMA Network Open investigators studied adults with atherosclerotic cardiovascular disease. Aspirin use for secondary prevention remained stable from 2015 to 2020 despite more negative messaging about aspirin for primary prevention. Most people who stopped aspirin did so because a physician recommended it, not because of a media report.

That should reassure clinicians who worry that headlines alone are driving people off evidence-based therapy. It should also remind patients not to start or stop aspirin on their own.

The Cancer Question Cardiology Often Ignores

There is one more wrinkle in the aspirin story. Cardiologists understandably focus on heart attacks, strokes and bleeding. Oncologists understandably focus on cancer diagnosis and treatment. But aspirin does not fit neatly into either specialty’s favorite box.

For decades, evidence has suggested that aspirin may have anti-cancer activity, especially against colorectal cancer. A meta-analysis in Annals of Oncology, April 1, 2020 reported that regular aspirin use was associated with a nearly a 30 percent reduction in colorectal cancer risk and also appeared linked to lower risk of some other digestive tract cancers.

More recently, a New England Journal of Medicine (Sept. 18, 2025) study found that low-dose aspirin reduced colorectal cancer recurrence among patients whose tumors had certain PI3K pathway alterations. So, genetic susceptibility factors may influence the anti-cancer effectiveness of aspirin.

Here is a story from a reader that reinforces that idea:

“I’m 76 years old, and I’ve taken an aspirin every day since I was 28 because of arthritis. Although cancer runs in my family on both sides, I’ve never had cancer of any sort.

“My dad died of prostate cancer. My mom has had breast cancer with both breasts removed. She also had skin cancer. My sister had breast cancer in both breasts. My first cousin had breast cancer and thyroid cancer. My aunt and another first cousin both died of colon cancer. None of them took aspirin unless they had a headache.

“Like another person who wrote to you, I definitely believe aspirin has helped me avoid cancer. I’ve taken an aspirin every day for almost 50 years.”

We do not want to overstate this. Aspirin is not a cancer cure. It is not a substitute for colonoscopy, surgery, chemotherapy, radiation, immunotherapy or any other proven cancer treatment. It can also cause ulcers, bleeding and dangerous drug interactions.

But it is puzzling that aspirin’s possible anti-cancer activity often gets treated as an afterthought. We have written about this in more detail here: “Aspirin and Cancer: The Overlooked Protection Hiding in Plain Sight” and “Did 15 Years Taking Aspirin Prevent Colorectal Cancer?”

Final Words About Aspirin for Your Heart

Aspirin is old. It is cheap. It is familiar. That may be part of the problem. Old, cheap and familiar medicines rarely get the respect granted to shiny new drugs with glossy ads, compelling TV commercials and eye-popping prices.

But aspirin is also powerful. It can prevent blood clots. It can cause bleeding. It may reduce the risk of some cancers. It may be inappropriate for many older adults trying to prevent a first heart attack. It may be essential for some people who have already had a cardiovascular event.

That is why the question should not be: “Is aspirin good or bad?”

The better question is: Is aspirin right for this person, at this age, with this medical history, this heart risk and this bleeding risk?

The JAMA Network Open (June 4, 2026) study reinforces something we have believed for a long time. The aspirin conversation should not be left to headlines, fear or fashion. It belongs in a thoughtful discussion between a patient and a knowledgeable health professional.

What do you think? Have you been advised to take aspirin for your heart? Were you told to stop? Did anyone explain the difference between primary and secondary prevention? Please share your experience in the comment section below.

You can read more about the benefits and risks of aspirin here.