The Truth About Baby Aspirin for Heart Health: Experts Reveal When It’s Helpful—and When It Isn’t

It’s a highly debated topic: Should you regularly take baby aspirin to protect your heart? While some research has shown that daily low-dose aspirin could be beneficial, other studies have presented no benefit and even raised concerns that the habit could harm your heart. So, we asked doctors to help shed some light on baby aspirin for heart health. 

What doctors say about baby aspirin and heart health

The guidance on daily aspirin for heart health has changed significantly over the years, confirms Ryan K. Kaple, MD, FACC, FSCAI, Director of the Structural & Congenital Heart Program at Hackensack University Medical Center. 

“It’s no longer generally recommended for primary prevention (preventing a first heart attack or stroke) and is only used in very specific circumstances for secondary prevention (preventing a second event),” he says. 

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The real risks of aspirin for heart attack prevention 

Aspirin is an antiplatelet drug, and platelets are blood cells that help form clots to stop bleeding, explains Dr. Kaple. In some cases, these clots can form inside blood vessels, blocking blood flow to the heart (heart attack) or brain (stroke). Low-dose aspirin interferes with platelet function and thins the blood, making it harder for these clots to form. That’s why it was once recommended to reduce the risk of heart attacks and stroke, especially for older adults, he adds. 

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“Newer research has shown that while low-dose aspirin can slightly reduce the risk of a first heart attack or stroke, it also significantly increases the risk of bleeding, particularly in the gastrointestinal tract and brain,” says Dr. Kaple. “For most people, the risk of bleeding outweighs the potential benefit of preventing a first cardiovascular event.”

This is especially true for women, who are particularly susceptible to brain bleeding, notes Bradley Serwer, MD, Interventional Cardiologist and Chief Medical Officer at VitalSolution, an Ingenovis Health company. This increased bleeding risk typically outweighs protective benefits in women with low or intermediate risk of cardiovascular disease. 

Who should still be taking daily baby aspirin

Daily aspirin might be considered in very select cases, says Dr. Kaple. For instance, a doctor might recommend low-dose aspirin for primary prevention of heart disease if a person has a higher risk of cardiovascular disease and a low risk of bleeding, he explains.  

It is crucial to note that this decision is made on a case-by-case basis after careful consideration of individual risk factors and a discussion between you and your doctor. It’s not a decision to make on your own, emphasizes Dr. Kaple. 

“Low-dose aspirin is still recommended for people who have already had a heart attack, stroke or other cardiovascular event,” he says. “In these cases, the benefit of preventing a second event generally outweighs the risk of bleeding.” Others with high cardiovascular risk, such as those with diabetes and additional risk factors, may also benefit, he adds.

Current guidelines also recommend daily aspirin therapy for individuals who have experienced ischemic stroke (lack of blood flow to the brain) for secondary preventative purposes as well as those at high risk of developing cardiovascular disease, adds Dr. Serwer. 

How much aspirin should you take?

Dr. Serwer personally recommends 81 mg of baby aspirin daily to patients who are not allergic and who have experienced a heart attack or ischemic stroke, particularly those who have undergone a stent procedure.

This is the standard dose (one baby aspirin), usually taken with food, adds Dr. Kaple. Enteric-coated versions of the pill may reduce stomach upset but do not lower the risk of internal bleeding, he cautions. 

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The bottom line on baby aspirin for heart health

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“Today, most cardiologists no longer recommend daily aspirin for women who have never had a heart attack, stroke or heart procedure since the risks outweigh the benefits,” summarizes Dr. Kaple. “Healthy women over age 60 are especially at risk for bleeding complications from aspirin.”

Instead of aspirin therapy, women with low-to-moderate risk of heart disease should focus on lifestyle changes such as eating a heart-healthy diet, exercising regularly, controlling blood pressure and not smoking, he advises. Regular medical checkups are important, too.

“Every woman’s heart health situation is different, so decisions about aspirin should be made with your doctor,” says Dr. Kaple. “Routine aspirin use is no longer a one-size-fits-all recommendation. Always talk to a healthcare provider before starting or stopping aspirin therapy.”