5 Medications That May Raise Heart Attack or Stroke Risk in Older Adults
Here’s the detail first: the claim that five medications simply “cause heart attacks and strokes” in older people is misleading. Many medications have legitimate medical uses, and the cardiovascular risk depends on the drug, dose, duration, existing health conditions, and other medicines being taken.
Some medications can, however, raise blood pressure, cause fluid retention, increase clotting or bleeding risk, or worsen cardiovascular conditions. Older adults can be particularly vulnerable, which is why medication reviews are important. PubMed Central (PMC)+1
1. NSAID Painkillers
Common nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen and naproxen.
These medicines can raise blood pressure and may increase cardiovascular risk in some people, particularly with higher doses or longer use. They can also cause fluid retention and worsen heart failure. www.heart.org+1
This doesn’t mean an older person can never take an NSAID. The goal is to use the lowest effective dose for the shortest appropriate period, particularly in people with cardiovascular disease.
2. Decongestants
Cold medicines containing pseudoephedrine or phenylephrine can constrict blood vessels and raise blood pressure.
This can be particularly concerning for people with severe or uncontrolled hypertension or established cardiovascular disease. Current hypertension guidance recommends avoiding these drugs in severe or uncontrolled hypertension and using them for the shortest possible duration when appropriate. www.heart.org+1
Always check the ingredients of combination cold and flu products because a decongestant may be included without being obvious from the product name.
3. Certain Antipsychotic Medications
Antipsychotics—including drugs such as risperidone, olanzapine, quetiapine, and haloperidol—can be appropriate and important treatments for certain psychiatric conditions.
But in older adults with dementia, these medications are associated with increased stroke risk and increased mortality. The American Geriatrics Society therefore recommends avoiding them for behavioral problems of dementia unless specific circumstances justify their use. PubMed Central (PMC)
They should never be stopped abruptly without medical advice.
4. Some Medications That Promote Fluid Retention
Certain medicines can cause or worsen fluid retention, which can be particularly problematic in people with heart failure.
The Beers Criteria specifically identifies NSAIDs and COX-2 inhibitors, among other drug classes, as medications that can worsen heart failure. PubMed Central (PMC)
If someone develops new leg swelling, rapid weight gain, worsening breathlessness, or difficulty lying flat after starting a medication, they should contact their healthcare professional.
5. Aspirin When Used for Primary Prevention
This one requires an important distinction.
Low-dose aspirin is an important treatment for many people who already have cardiovascular disease, but routinely starting aspirin solely to prevent a first heart attack or stroke isn’t appropriate for every older adult.
The 2023 Beers Criteria recommends against initiating aspirin for primary cardiovascular prevention in older adults, because bleeding risk increases with age and the overall benefit may not outweigh the harm. PubMed Central (PMC)
That does not mean everyone currently taking aspirin should stop. Someone taking aspirin after a previous heart attack, stroke, or other cardiovascular event may have a strong reason to continue it.
Why Medication Reviews Matter
Older adults often take several medications simultaneously. The problem isn’t always one individual drug—it can be the combination.
For example, NSAIDs can interact with blood-pressure treatment and may worsen fluid retention, while multiple medications can collectively increase dizziness, falls, or other complications.
A pharmacist or doctor can review:
- Prescription medicines
- Over-the-counter painkillers
- Cold and flu products
- Vitamins
- Herbal supplements
- Dosages and frequency
- Possible drug interactions
Don’t Stop Your Medication Suddenly
This is especially important with cardiovascular and psychiatric medications.
Never discontinue a prescribed medication simply because you’ve seen a warning online. Stopping some medicines abruptly can itself cause dangerous problems.
Instead, ask your doctor or pharmacist:
“Could any of my medications be increasing my blood pressure, fluid retention, bleeding risk, or cardiovascular risk?”
That question can lead to a much more useful medication review.
Warning Signs That Need Urgent Attention
Seek emergency medical care for symptoms such as:
- Sudden chest pressure or severe chest pain
- Severe difficulty breathing
- Sudden weakness or numbness, especially on one side
- Sudden trouble speaking or understanding speech
- Sudden loss of vision
- Fainting or severe unexplained collapse
These can be signs of a heart attack or stroke, regardless of whether medication is involved.
Final Takeaway
There isn’t a universal list of five medications that older people should avoid because they “cause heart attacks and strokes.”
However, NSAIDs, certain decongestants, some antipsychotics in people with dementia, medications that worsen fluid retention, and aspirin used for primary prevention can present important risks in particular circumstances. PubMed Central (PMC)+2
The safest approach is individual medication review rather than stopping medicines based on a headline. A drug that is risky for one person may be highly beneficial—and even lifesaving—for another.
