For decades, a daily low-dose aspirin was hailed as a simple, low-risk, life-saving measure for virtually all people over age 60 — irrespective of their health history. It was the kind of advice that felt like common sense: take a tiny pill, thin your blood, and stave off heart attacks and strokes.

But in 2019, the medical establishment delivered a wake-up call. The American College of Cardiology and the American Heart Association (AHA) revised their guidelines, warning that for most healthy adults, the risks of daily aspirin — particularly gastrointestinal bleeding — now outweighed the benefits.

However, most Americans didn’t get the memo.

According to a recent survey by the Annenberg Public Policy Center (APPC) at the University of Pennsylvania, nearly half (48%) of U.S. adults still believe that for most people, the benefits of daily low-dose aspirin outweigh the risks. Even more concerning: 18% of adults with no personal or family history of heart attack or stroke report taking aspirin regularly, with 10% saying they take it “basically every day.”

“Habits backed by conventional wisdom and the past advice of health care providers are hard to break,” said Kathleen Hall Jamieson, director of the APPC and the survey. “Knowing whether taking a low-dose aspirin daily is advisable or not for you is vital health information.”

The Shifting Science of Aspirin

Aspirin’s appeal lies in its ability to thin blood and prevent clots, which can clog arteries and lead to heart attacks or strokes (when the blood clots form in the brain). For decades, doctors recommended it as a preventive measure for healthy adults, particularly those over 70, but previous guidelines also included those over 60. But as researchers dug deeper, they found problems with this advice.

In 2022, the U.S. Preventive Services Task Force reinforced the AHA’s guidelines, recommending against starting a daily aspirin regimen for adults 60 and older without a history of cardiovascular disease. For those aged 40 to 59 with a 10% or greater 10-year risk of cardiovascular disease, the decision is left to individual patients and their doctors.

“In cardiovascular disease, we commonly prefer blood thinning because many cardiovascular diseases are the result of blood clots,” said Dr. Michael J. Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. “However, blood thinning is inevitably accompanied by an increased risk of bleeding,” he added during an interview with USA Today.

This bleeding risk is no small matter. Aspirin can weaken the stomach’s protective lining, making it more vulnerable to ulcers and gastrointestinal bleeding. For older adults, who are already at higher risk for such complications, the dangers can outweigh the benefits.

Who Should (and Shouldn’t) Take Aspirin?

The survey highlights a troubling gap in public understanding. Among respondents with no history of heart attack or stroke, 43% still believe the benefits of daily aspirin outweigh the risks. Younger adults, however, are more likely to recognize the dangers: 29% of those aged 18 to 39 correctly say the risks outweigh the benefits, compared to just 7% of those 60 and older.

This generational divide may reflect familiarity with older guidelines. “Too many low-risk patients were taking aspirin in the past, sometimes without consulting a medical professional,” Blaha noted.

The AHA estimates that 48% of U.S. adults aged 20 and older have some form of cardiovascular disease, including hypertension. For these individuals, aspirin may still be advisable. But for healthy adults, the message is clear: daily aspirin is not a one-size-fits-all solution and may end up doing more harm than good.

The persistence of outdated beliefs underscores the challenges of changing public health messaging. “Conventional wisdom is hard to break,” Jamieson said. “But it’s essential that people understand the current guidelines.”

For now, experts urge caution. If you’re considering daily aspirin, talk to your doctor. And if you’re already taking it, don’t stop without consulting a medical professional — especially if you have a history of heart attack or stroke.

What was once a medical mantra — take an aspirin a day — is now a nuanced decision, one that requires careful consideration of risks and benefits. For many Americans, it’s time to rethink the pill in the cabinet.