Daily aspirin can be worthwhile for specific at-risk groups (ages 40-59 with high cardiovascular risk, pregnant women at risk of pre-eclampsia), but is inadvisable for people aged 60 and older without cardiovascular disease due to the bleeding risk. The decision always requires an individual medical assessment.
Taking an aspirin every day sounds simple, but whether it is smart or dangerous depends entirely on who you are and why you are doing it. There is no single answer that applies to everyone.
For people between the ages of 40 and 59 with an elevated risk of cardiovascular disease (a 10% or greater chance of a heart attack or stroke in the next 10 years), the U.S. Preventive Services Task Force (USPSTF) indicates that a daily low-dose aspirin offers a small but real benefit. The decision must, however, be made on an individual basis: only those who do not have an increased risk of bleeding and who are willing to take aspirin consistently have the greatest chance of benefiting. The benefit is modest, not spectacular.
For people aged 60 or older without known cardiovascular disease, the conclusion is clear and striking: do not start taking daily aspirin. The USPSTF states with moderate certainty that in this age group the harms, particularly the risk of dangerous bleeding (such as in the stomach or brain), outweigh the benefits. Starting aspirin at an older age purely as a preventive measure is explicitly discouraged.
Around surgery (non-cardiac operations), routine aspirin use is also inadvisable: it does not reduce cardiac events, but does increase the risk of surgical bleeding. This is a safety risk that carries significant weight in clinical practice.
There are specific situations in which aspirin is clearly beneficial. In pregnant women at high risk of pre-eclampsia (a serious pregnancy complication), low-dose aspirin reduces the risk of that complication, of preterm birth, and of harm to both mother and child. In the rare blood disorder essential thrombocythemia, aspirin is in fact recommended to prevent blood clots. And European gastrointestinal specialists state that aspirin may also offer some protection against stomach cancer in people with a high cardiovascular risk, although that evidence is more limited and applies to a select group.
The common thread: aspirin is not an innocent vitamin pill. The bleeding risk is real and increases with age. Take it only on a doctor's advice, tailored to your personal risk profile, and never start or stop it on your own.
All claims are based on guidelines and reviews (USPSTF 2022, ESGE/EHMSG/ESP 2023, a perioperative study), with PMIDs 35471505, 32692391, 40112834, and 38269572. No raw RCT data directly available; the strength of evidence per subgroup is moderate.