“An Aspirin a Day?” — Why the Answer Is No Longer So Simple

by Richard A. Howard, MD, FACC, FSCAI

February is Heart Health Month, and we’re proud to present The Heart of the Matter, an essential collection of articles from leading cardiologist Richard A. Howard, MD, FACC, FSCAI. Moving beyond general health tips, Dr. Howard provides expert insights, clarifies common misconceptions, and offers actionable, evidence-based strategies you can use immediately to protect and strengthen your cardiovascular health. From understanding your risk factors to incorporating heart-smart lifestyle changes, this collection is your definitive guide to a healthier heart.

For decades, many Americans believed a simple idea: take a baby aspirin every day and you can prevent a heart attack or stroke. That advice was once widely given—and for some people, it is still lifesaving.

But in recent years, headlines have suggested the opposite: “Stop taking aspirin.” Unfortunately, some people have taken that message to heart—without talking to their doctor first. As a cardiologist, I have seen the consequences firsthand: heart attacks, strokes, and blood clots forming inside coronary stents after aspirin was stopped abruptly.

The truth is this: aspirin is neither good for everyone nor bad for everyone. Whether you should take it depends on why you are taking it in the first place.

Primary Prevention vs. Secondary Prevention
Primary prevention means preventing a first heart attack or stroke in someone who has never had one before. For many low-risk adults, aspirin may not provide much benefit and can increase bleeding risk. Secondary prevention is entirely different. This means preventing another heart attack or stroke in someone who has already had one. If you have had a heart attack, stroke, coronary stent, bypass surgery, or known coronary artery disease, aspirin is foundational therapy and should not be stopped without medical guidance.

Who May Still Benefit
Higher-risk individuals—such as those with diabetes, strong family history, high coronary calcium scores, or multiple risk factors—may still benefit from aspirin. The decision should always be individualized.

The Most Important Message
Never start or stop aspirin without discussing it with your physician. A short conversation may prevent a life-altering event.