Top of the pageDecision Point
Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?
You may want to have a say in this decision, or you may simply want to follow your doctor’s recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?
1Get the |
2Compare |
3Your |
4Get the |
5Quiz |
6Your Summary |
Get the facts
Your options
- Take daily aspirin.
- Don’t take daily aspirin.
Is this decision for you? This could be a decision for you if you have NOT had a heart attack or a stroke. Aspirin is strongly recommended for people who have been diagnosed with heart disease or who have had a heart attack or some kinds of strokes.
Key points to remember
- Aspirin lowers the chance of having a heart attack. The benefit is greatest for people at high risk of a heart attack. It is not clear that aspirin can help prevent a stroke.
- You can work with your doctor to find out your risk of heart attack. Your risk is based on your cholesterol levels, blood pressure, age, sex, and other things, including whether you smoke.
- Taking aspirin isn’t right for everyone, because it can cause serious bleeding. You and your doctor can decide if aspirin is a good choice for you based on your risk of heart attack and your risk of serious bleeding.
- If you have a high risk for a heart attack, you may decide that the benefits of aspirin outweigh the chance of serious bleeding.
- If you have a low risk of a heart attack, the benefits of aspirin probably won’t outweigh the risk of bleeding.
- Even if you take aspirin every day, you can do other things to reduce your chance of having a heart attack. They include eating healthy foods, getting regular exercise, staying at a healthy weight, and not smoking. You also need to manage other health problems that increase your risk, such as diabetes, high blood pressure, and high cholesterol.
How can you know your risk for a heart attack?
Your doctor can estimate your risk for a heart attack in the next 10 years. Your doctor may use a tool called a risk calculator to figure out your risk. The tools are not perfect. They may show that your risk is higher or lower than it really is. But they can give you and your doctor a good idea about your risk.
There are different calculators, but they all include details about your health. They include whether you:
- Have high cholesterol.
- Have high blood pressure.
- Have diabetes.
- Are male.
- Are African-American.
- Are older.
- Smoke.
The more of these factors you have, the higher your risk of a heart attack.
- If you have a low risk of heart attack, the benefits of taking aspirin probably won’t outweigh the chance of serious bleeding.
- If you have a high risk of heart attack, you may decide that the benefits of aspirin outweigh the chance of serious bleeding.
What lifestyle changes can lower your chance of heart attack?
Even if you take aspirin, you can do other things to reduce your chance of having a heart attack.
- Eat healthy foods.
- Get regular exercise.
- Stay at a healthy weight. Lose weight if you need to.
- Don’t smoke.
- Manage other health problems, such as diabetes, high blood pressure, and high cholesterol.
How might aspirin prevent a heart attack?
A heart attack occurs when a blood clot forms in one of the blood vessels that supply the heart muscle. Aspirin can prevent blood clots from forming in your arteries. This may help prevent a heart attack.
Can aspirin prevent a stroke?
It is not clear that aspirin can help prevent a stroke.footnote 1 Some experts recommend that certain women take aspirin to help prevent a stroke, depending on their age and other things.footnote 1
What are the risks of taking aspirin?
When you take aspirin, your blood clots more slowly. This increases your chance of bleeding problems, which can be serious.
Aspirin can cause your stomach or another part of your digestive tract to bleed. Rarely, aspirin causes bleeding in other parts of the body, including the brain.
The risk of bleeding isn’t the same for everyone. Your doctor can help you know your risk of bleeding based on your age and your health. For example, people’s risk of bleeding gets higher as they get older.
Some people have other problems from aspirin. These include an allergic reaction, stomach pain, and nausea.
What do numbers tell us about benefits and risks of aspirin?
Benefits
| Risk of heart attack | Without aspirin | With aspirin |
|---|---|---|
| Low risk | 3 out of 100 | 2 out of 100 |
| Moderate risk | 10 out of 100 | 8 out of 100 |
| High risk | 20 out of 100 | 16 out of 100 |
*These numbers are examples based on research studies.footnote 1
Evidence shows that aspirin lowers the chance of heart attack, especially for people with a high risk of heart attack. The quality of this evidence is moderate.
Take a group of 100 people who have a low risk of heart attack. Here are their chances of having one in the next 10 years:footnote 1
- Without aspirin, about 3 out of 100 will have a heart attack. This means that about 97 out of 100 won’t have one.
- With aspirin, about 2 out of 100 will have a heart attack. This means that about 98 out of 100 won’t.
Take a group of 100 people who have a moderate risk of heart attack. Here are their chances of having one in the next 10 years:footnote 1
- Without aspirin, about 10 out of 100 people will have a heart attack. This means that about 90 out of 100 won’t have one.
- With aspirin, about 8 out of 100 people will have a heart attack. This means that about 92 out of 100 won’t have one.
Take a group of 100 people who have a high risk of heart attack. Here are their chances of having one in the next 10 years:footnote 1
- Without aspirin, about 20 out of 100 people will have a heart attack. This means that about 80 out of 100 won’t have one.
- With aspirin, about 16 out of 100 people will have a heart attack. This means that about 84 out of 100 won’t.
Risks
| | Number of serious bleeding problems within 10 years | |
|---|---|---|
| Risk of serious bleeding | Without aspirin | With aspirin |
| Low risk | 1 out of 100 | 2 out of 100 |
| Moderate risk | 10 out of 100 | 15 out of 100 |
| High risk | 20 out of 100 | 31 out of 100 |
*These numbers are examples based on research studies.footnote 1
Evidence shows that aspirin increases the chance of serious bleeding in the digestive tract. The quality of this evidence is moderate.
Take a group of 100 people who have a low risk of bleeding. Here are their chances of having serious bleeding in the next 10 years:footnote 1
- Without aspirin, about 1 out of 100 will have serious bleeding. This means that 99 out of 100 won’t.
- With aspirin, about 2 out of 100 will have serious bleeding. This means that about 98 out of 100 won’t.
Take a group of 100 people who have a moderate risk of bleeding. Here are their chances of having serious bleeding in the next 10 years:footnote 1
- Without aspirin, about 10 out of 100 people will have serious bleeding. This means that 90 out of 100 won’t.
- With aspirin, about 15 out of 100 people will have serious bleeding. This means that 85 out of 100 won’t.
Take a group of 100 people who have a high risk of bleeding. Here are their chances of having serious bleeding in the next 10 years:footnote 1
- Without aspirin, about 20 out of 100 people will have serious bleeding. This means that about 80 out of 100 won’t.
- With aspirin, about 31 out of 100 people will have serious bleeding. This means that about 69 out of 100 won’t.
Understanding the evidence
Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.
The information shown here is based on the best available evidence.footnote 1
The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.
Another thing to understand is that the evidence can’t predict what’s going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there’s no way to know if you will be one of the 2 or one of the 98.
Who can’t take daily aspirin?
People who have certain health problems shouldn’t take aspirin. These include people who:
- Have recently had a stomach ulcer or bleeding in the digestive tract.
- Have recently had a stroke caused by bleeding in the brain.
- Are allergic to aspirin.
- Have asthma that is made worse by aspirin.
Compare your options
Compare
|
What is usually involved? |
||
|---|---|---|
|
What are the benefits? |
||
|
What are the risks and side effects? |
- You take aspirin as your doctor recommends. Most people take it every day.
- You have a heart-healthy lifestyle. This includes being active, eating healthy foods, staying at a healthy weight, and not smoking.
- Aspirin lowers the chance of a heart attack. The benefit is greatest for people at high risk of a heart attack.
- It is not clear that aspirin can help prevent a stroke.
- Aspirin increases the risk of serious bleeding.
- Aspirin can cause side effects and other problems, such as an allergic reaction.
- You have a heart-healthy lifestyle such as being active, eating healthy foods, staying at a healthy weight, and not smoking.
- You avoid the problems of aspirin, such as serious bleeding.
- You avoid the bother and cost of taking aspirin every day.
- Healthy habits alone will not lower your chance of a heart attack as much as healthy habits plus taking aspirin would. That’s especially true for people with a high risk of heart attack.
Personal stories about taking daily aspirin to prevent a heart attack
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I’ve got high blood pressure. And my father died of a heart attack. Based on my risks, I decided it would be a good idea if I took a baby aspirin every day. My doctor agreed. It’s no big deal. I take it at night when I go to bed.
Paul, age 63
I’ve got diabetes. My doctor explained my risk and showed me that aspirin would be helpful for me because people with diabetes have a higher risk of a heart attack. My blood sugar is under pretty good control. But I want to do everything I can to stay healthy, so I’m taking an aspirin every morning.
Graciela, age 61
I’m taking medicine for high cholesterol and high blood pressure. I wondered if I should be taking aspirin too, but my doctor said it could increase the risk of bleeding. I’ve had stomach ulcers off and on over the years, so aspirin would not be a good choice for me. I’ll just keep my weight down and keep taking my cholesterol and blood pressure medicines.
Cal, age 48
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take daily aspirin
Reasons not to take daily aspirin
I’m willing to take pills every day to help prevent a heart attack.
I don’t like taking pills.
I am more worried about having a heart attack than the risk of serious bleeding problems.
I am more worried about the problem of serious bleeding than my risk of a heart attack.
I want to do everything I can to lower my chance of having a heart attack.
I think I’m doing enough to lower my chance of having a heart attack.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you’ve thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking daily aspirin
NOT taking daily aspirin
What else do you need to make your decision?
Check the facts
Decide what’s next
Certainty
1. How sure do you feel right now about your decision?
Your Summary
Here’s a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you’re leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
| Author | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai MD, FACC – Cardiology, Electrophysiology |
| Primary Medical Reviewer | Adam Husney MD – Family Medicine |
| Primary Medical Reviewer | Martin J. Gabica MD – Family Medicine |
| Primary Medical Reviewer | Elizabeth T. Russo MD – Internal Medicine |
| Primary Medical Reviewer | Michael P. Pignone MD, MPH, FACP – Internal Medicine |
- Antithrombotic Trialists’ (ATT) Collaboration (2009). Aspirin in the primary and secondary prevention of vascular disease: Collaborative meta-analysis of individual participant data from randomised trials. Lancet, 373(9678): 1849–1860. DOI: http://dx.doi.org/10.1016/S0140-6736(09)60503-1. Accessed February 12, 2015.
Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- Take daily aspirin.
- Don’t take daily aspirin.
Is this decision for you? This could be a decision for you if you have NOT had a heart attack or a stroke. Aspirin is strongly recommended for people who have been diagnosed with heart disease or who have had a heart attack or some kinds of strokes.
Key points to remember
- Aspirin lowers the chance of having a heart attack. The benefit is greatest for people at high risk of a heart attack. It is not clear that aspirin can help prevent a stroke.
- You can work with your doctor to find out your risk of heart attack. Your risk is based on your cholesterol levels, blood pressure, age, sex, and other things, including whether you smoke.
- Taking aspirin isn’t right for everyone, because it can cause serious bleeding. You and your doctor can decide if aspirin is a good choice for you based on your risk of heart attack and your risk of serious bleeding.
- If you have a high risk for a heart attack, you may decide that the benefits of aspirin outweigh the chance of serious bleeding.
- If you have a low risk of a heart attack, the benefits of aspirin probably won’t outweigh the risk of bleeding.
- Even if you take aspirin every day, you can do other things to reduce your chance of having a heart attack. They include eating healthy foods, getting regular exercise, staying at a healthy weight, and not smoking. You also need to manage other health problems that increase your risk, such as diabetes, high blood pressure, and high cholesterol.
How can you know your risk for a heart attack?
Your doctor can estimate your risk for a heart attack in the next 10 years. Your doctor may use a tool called a risk calculator to figure out your risk. The tools are not perfect. They may show that your risk is higher or lower than it really is. But they can give you and your doctor a good idea about your risk.
There are different calculators, but they all include details about your health. They include whether you:
- Have high cholesterol.
- Have high blood pressure.
- Have diabetes.
- Are male.
- Are African-American.
- Are older.
- Smoke.
The more of these factors you have, the higher your risk of a heart attack.
- If you have a low risk of heart attack, the benefits of taking aspirin probably won’t outweigh the chance of serious bleeding.
- If you have a high risk of heart attack, you may decide that the benefits of aspirin outweigh the chance of serious bleeding.
What lifestyle changes can lower your chance of heart attack?
Even if you take aspirin, you can do other things to reduce your chance of having a heart attack.
- Eat healthy foods.
- Get regular exercise.
- Stay at a healthy weight. Lose weight if you need to.
- Don’t smoke.
- Manage other health problems, such as diabetes, high blood pressure, and high cholesterol.
How might aspirin prevent a heart attack?
A heart attack occurs when a blood clot forms in one of the blood vessels that supply the heart muscle. Aspirin can prevent blood clots from forming in your arteries. This may help prevent a heart attack.
Can aspirin prevent a stroke?
What are the risks of taking aspirin?
When you take aspirin, your blood clots more slowly. This increases your chance of bleeding problems, which can be serious.
Aspirin can cause your stomach or another part of your digestive tract to bleed. Rarely, aspirin causes bleeding in other parts of the body, including the brain.
The risk of bleeding isn’t the same for everyone. Your doctor can help you know your risk of bleeding based on your age and your health. For example, people’s risk of bleeding gets higher as they get older.
Some people have other problems from aspirin. These include an allergic reaction, stomach pain, and nausea.
What do numbers tell us about benefits and risks of aspirin?
Benefits
| Risk of heart attack | Without aspirin | With aspirin |
|---|---|---|
| Low risk | 3 out of 100 | 2 out of 100 |
| Moderate risk | 10 out of 100 | 8 out of 100 |
| High risk | 20 out of 100 | 16 out of 100 |
*These numbers are examples based on research studies.1
Evidence shows that aspirin lowers the chance of heart attack, especially for people with a high risk of heart attack. The quality of this evidence is moderate.
Take a group of 100 people who have a low risk of heart attack . Here are their chances of having one in the next 10 years:1
- Without aspirin, about 3 out of 100 will have a heart attack. This means that about 97 out of 100 won’t have one.
- With aspirin, about 2 out of 100 will have a heart attack. This means that about 98 out of 100 won’t.
Take a group of 100 people who have a moderate risk of heart attack . Here are their chances of having one in the next 10 years:1
- Without aspirin, about 10 out of 100 people will have a heart attack. This means that about 90 out of 100 won’t have one.
- With aspirin, about 8 out of 100 people will have a heart attack. This means that about 92 out of 100 won’t have one.
Take a group of 100 people who have a high risk of heart attack . Here are their chances of having one in the next 10 years:1
- Without aspirin, about 20 out of 100 people will have a heart attack. This means that about 80 out of 100 won’t have one.
- With aspirin, about 16 out of 100 people will have a heart attack. This means that about 84 out of 100 won’t.
Risks
| | Number of serious bleeding problems within 10 years | |
|---|---|---|
| Risk of serious bleeding | Without aspirin | With aspirin |
| Low risk | 1 out of 100 | 2 out of 100 |
| Moderate risk | 10 out of 100 | 15 out of 100 |
| High risk | 20 out of 100 | 31 out of 100 |
*These numbers are examples based on research studies.1
Evidence shows that aspirin increases the chance of serious bleeding in the digestive tract. The quality of this evidence is moderate.
Take a group of 100 people who have a low risk of bleeding . Here are their chances of having serious bleeding in the next 10 years:1
- Without aspirin, about 1 out of 100 will have serious bleeding. This means that 99 out of 100 won’t.
- With aspirin, about 2 out of 100 will have serious bleeding. This means that about 98 out of 100 won’t.
Take a group of 100 people who have a moderate risk of bleeding . Here are their chances of having serious bleeding in the next 10 years:1
- Without aspirin, about 10 out of 100 people will have serious bleeding. This means that 90 out of 100 won’t.
- With aspirin, about 15 out of 100 people will have serious bleeding. This means that 85 out of 100 won’t.
Take a group of 100 people who have a high risk of bleeding . Here are their chances of having serious bleeding in the next 10 years:1
- Without aspirin, about 20 out of 100 people will have serious bleeding. This means that about 80 out of 100 won’t.
- With aspirin, about 31 out of 100 people will have serious bleeding. This means that about 69 out of 100 won’t.
Understanding the evidence
Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.
The information shown here is based on the best available evidence.1
The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.
Another thing to understand is that the evidence can’t predict what’s going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there’s no way to know if you will be one of the 2 or one of the 98.
Who can’t take daily aspirin?
People who have certain health problems shouldn’t take aspirin. These include people who:
- Have recently had a stomach ulcer or bleeding in the digestive tract.
- Have recently had a stroke caused by bleeding in the brain.
- Are allergic to aspirin.
- Have asthma that is made worse by aspirin.
2. Compare your options
| Take daily aspirin | Don’t take daily aspirin | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Personal stories about taking daily aspirin to prevent a heart attack
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
“I’ve got high blood pressure. And my father died of a heart attack. Based on my risks, I decided it would be a good idea if I took a baby aspirin every day. My doctor agreed. It’s no big deal. I take it at night when I go to bed.”
— Paul, age 63
“I read about aspirin and how it can prevent a heart attack, so I talked with my doctor about it. After looking at the numbers, I could see that my risk of having a heart attack was really low. My blood pressure and cholesterol are all good, and I have a pretty healthy lifestyle. But we’ll keep an eye on everything, and if it looks like my chances for a heart attack are going up, I can think about taking aspirin then.”
Yvonne, age 52
“I’ve got diabetes. My doctor explained my risk and showed me that aspirin would be helpful for me because people with diabetes have a higher risk of a heart attack. My blood sugar is under pretty good control. But I want to do everything I can to stay healthy, so I’m taking an aspirin every morning.”
— Graciela, age 61
“I’m taking medicine for high cholesterol and high blood pressure. I wondered if I should be taking aspirin too, but my doctor said it could increase the risk of bleeding. I’ve had stomach ulcers off and on over the years, so aspirin would not be a good choice for me. I’ll just keep my weight down and keep taking my cholesterol and blood pressure medicines.”
— Cal, age 48
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take daily aspirin
Reasons not to take daily aspirin
I’m willing to take pills every day to help prevent a heart attack.
I don’t like taking pills.
I am more worried about having a heart attack than the risk of serious bleeding problems.
I am more worried about the problem of serious bleeding than my risk of a heart attack.
I want to do everything I can to lower my chance of having a heart attack.
I think I’m doing enough to lower my chance of having a heart attack.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you’ve thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking daily aspirin
NOT taking daily aspirin
5. What else do you need to make your decision?
Check the facts
1. I will get the most benefit from taking an aspirin if I have a higher risk of a heart attack.
- True
- False
- I’m not sure
2. If I have certain health problems, I may not be able to take aspirin.
- True
- False
- I’m not sure
3. I don’t have to worry about any side effects from taking aspirin every day.
- True
- False
- I’m not sure
4. If I take a daily aspirin, it’s not as important for me to follow a heart-healthy lifestyle.
- True
- False
- I’m not sure
Decide what’s next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I’m ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai MD, FACC – Cardiology, Electrophysiology |
| Primary Medical Reviewer | Adam Husney MD – Family Medicine |
| Primary Medical Reviewer | Martin J. Gabica MD – Family Medicine |
| Primary Medical Reviewer | Elizabeth T. Russo MD – Internal Medicine |
| Primary Medical Reviewer | Michael P. Pignone MD, MPH, FACP – Internal Medicine |
- Antithrombotic Trialists’ (ATT) Collaboration (2009). Aspirin in the primary and secondary prevention of vascular disease: Collaborative meta-analysis of individual participant data from randomised trials. Lancet, 373(9678): 1849–1860. DOI: http://dx.doi.org/10.1016/S0140-6736(09)60503-1. Accessed February 12, 2015.
Note: The “printer friendly” document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Current as of: April 9, 2019
Author: Healthwise Staff
Medical Review:Rakesh K. Pai MD, FACC – Cardiology, Electrophysiology & Adam Husney MD – Family Medicine & Martin J. Gabica MD – Family Medicine & Elizabeth T. Russo MD – Internal Medicine & Michael P. Pignone MD, MPH, FACP – Internal Medicine