29 million Americans take this daily for heart health—most don’t realize the risks

By Meghan McCallum | Fact-checked by Barbara Bekiesz

Published February 18, 2025

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“A common misconception about aspirin is that it is harmless. In actuality, the bleeding risk with aspirin (while low) can be significant and should be weighed against the potential benefits.” – Abhayjit Singh, MD

Find more of your peers' perspectives and insights below.

Times are changing when it comes to heart health, and aspirin may be more harmful than we once thought. While aspirin has long been recommended as primary protection to protect against cardiovascular disease, more recent guidelines advise much more caution against its risks.

In particular, concerns are rising for bleeding risk among patients taking aspirin. For many, this risk may outweigh the potential benefits.

Continue reading for expert guidance on aspirin’s risks and benefits and how to support patients’ heart health.

Aspirin: Not so harmless after all

Despite the seemingly benign nickname “baby aspirin,” even low-dose aspirin is no longer considered without serious risk. Dr. Abhayjit Singh, cardiologist at the Cleveland Clinic, explains: “A common misconception about aspirin is that it is harmless. In actuality, the bleeding risk with aspirin (while low) can be significant and should be weighed against the potential benefits.”

In particular, regular aspirin use increases patients’ bleeding risk. According to the Mayo Clinic, daily use “can have serious side effects, including gastrointestinal bleeding.”^[]

When do risks outweigh benefits?

More recent research and guidelines help distinguish between categories of patients who face more risk versus those who may still be advised to take aspirin.

The key lies in the patient’s existing risk for heart disease; aspirin is considered more risky for patients who do not have established heart disease. Guidelines published in 2019 by the American Heart Association (AHA) and the American College of Cardiology state: “Prophylactic aspirin in primary-prevention adults >70 years of age is potentially harmful and, given the higher risk of bleeding in this age group, difficult to justify for routine use.”^[]

In 2019, the AHA also reported: “According to three significant studies published last year and one major analysis released this year that looked at 10 other studies, the benefit from taking a daily low-dose aspirin was offset by the danger of internal bleeding and other side effects in people considered to be at low or moderate risk for heart disease.” The AHA’s position, therefore, was that today, “the benefit for taking aspirin for the majority of otherwise healthy adults just doesn't outweigh the risks enough.”^[]

This does not apply to people who already have cardiovascular disease, however. As the AHA notes, for these patients, aspirin may still be necessary. “Aspirin still may be considered for very select high-risk adults ages 40-70 who are not at increased risk for bleeding, if advised by their doctors.”

Dr. Singh adds, “Aspirin remains a very important therapy for patients being treated for secondary prevention (history of heart attack, stroke, coronary stenting, bypass surgery, etc.), and patients should not discontinue use without first discussing with their doctor.”

These risks and benefits must be clearly communicated to patients. “In order to better communicate with patients about aspirin, doctors should be clear about the indication for aspirin and counsel patients accordingly,” Dr. Singh says.

Lifestyle choices to promote heart health

The 2019 AHA/ACC Guidelines recommend other approaches to preventing cardiovascular disease, including:^[]

Assess cardiovascular risk with a clinician before starting pharmacological therapy
Consume a healthy diet emphasizing vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish; minimize the intake of trans fats, red meat and processed red meats, refined carbohydrates, and sweetened beverages
Complete at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity
Quit tobacco use