A Cardiologist Warns: These 5 Medications Can Increase Heart Attack and Stroke Risk in Older People
Medication safety becomes increasingly important with age because older adults are more likely to take several medicines at the same time, and age-related changes in kidney and liver function can alter how medications are processed. Importantly, these medicines are not automatically dangerous for every older person. Their risks depend on the drug, dose, duration, existing heart disease, blood pressure, other medications, and individual health circumstances. U.S. Food and Drug Administration
1. NSAID Painkillers
Nonsteroidal anti-inflammatory drugs (NSAIDs) include medicines such as ibuprofen, naproxen, diclofenac, and celecoxib.
These medicines are commonly used for arthritis, back pain, muscle aches, and inflammation. However, NSAIDs can increase the risk of serious cardiovascular events, including heart attack and stroke. The FDA warns that the risk can occur relatively early in treatment and may increase with higher doses and longer use. FDA Access Data+1
The concern can be greater in people who already have cardiovascular disease or cardiovascular risk factors because their baseline risk is already elevated.
NSAIDs can also cause fluid retention, raise blood pressure, and increase the risk of gastrointestinal bleeding. Older adults are particularly vulnerable to medication-related complications.
If you regularly use an NSAID for chronic pain, don’t simply assume that an over-the-counter medicine is harmless. Ask your doctor or pharmacist whether the particular drug, dose, and duration are appropriate for you.
2. Decongestants Containing Pseudoephedrine or Phenylephrine
Some cold and sinus medicines contain decongestants such as pseudoephedrine or phenylephrine.
These medicines work partly by constricting blood vessels, which can help reduce nasal congestion. Unfortunately, that same effect can increase blood pressure and place additional stress on the cardiovascular system.
The American Heart Association notes that decongestants can be particularly concerning for people with high blood pressure or heart disease. www.heart.org
This doesn’t mean every older adult must completely avoid cold medicine. It means that people with hypertension, heart disease, previous stroke, or other cardiovascular conditions should check with a healthcare professional before using systemic decongestants.
Also remember that many combination cold products contain multiple active ingredients. Accidentally taking two products containing the same decongestant or painkiller can result in excessive dosing.
3. Certain Prescription NSAIDs Used for Long-Term Pain
Not all cardiovascular medication concerns come from drugs that people think of as “heart medicines.”
Prescription-strength NSAIDs can expose people to higher doses for longer periods, potentially increasing cardiovascular risk.
The FDA states that NSAIDs can increase the chance of heart attack or stroke and recommends using the lowest effective dose for the shortest possible duration when these medications are appropriate. U.S. Food and Drug Administration
If you have previously had a heart attack, stroke, heart failure, or significant cardiovascular disease, make sure your doctor knows before you regularly use an NSAID.
Don’t discontinue a prescribed medicine on your own. Your clinician may be able to recommend another pain-management strategy that better fits your cardiovascular risk.
4. Certain Medicines That Raise Blood Pressure or Cause Fluid Retention
Some medications can increase blood pressure or cause the body to retain sodium and fluid.
For an older adult who already has hypertension or heart failure, these effects can be particularly important.
NSAIDs are one example. Other medications can have cardiovascular effects depending on the individual’s circumstances.
The important lesson is to look at the entire medication list, rather than assuming that one particular class is dangerous for everyone.
This becomes especially important when you take several prescriptions plus over-the-counter medicines, vitamins, or supplements. The FDA specifically advises older adults to maintain an updated medication list and discuss potential interactions with healthcare professionals. U.S. Food and Drug Administration
5. Aspirin When It Isn’t Medically Indicated
Aspirin requires special clarification because it can actually be beneficial for certain people.
For people who have already had a heart attack, certain types of stroke, or established cardiovascular disease, doctors may prescribe aspirin to reduce the risk of another cardiovascular event.
But taking daily aspirin simply because you’re older—or because you want to prevent your first heart attack—may not provide enough benefit to outweigh its bleeding risks.
The FDA warns that aspirin can cause serious bleeding, including bleeding in the stomach or brain, and recommends that people discuss regular aspirin therapy with a healthcare professional. U.S. Food and Drug Administration+1
Therefore, aspirin shouldn’t be placed into the category of “dangerous heart medications” without context. The right question is whether aspirin is appropriate for your particular cardiovascular risk.
If your doctor prescribed aspirin for an established medical reason, don’t stop it without speaking with them.
Why Older Adults Need Extra Caution
As we age, changes in kidney and liver function can affect how medicines are broken down and eliminated.
Older adults are also more likely to take several medications simultaneously, increasing the possibility of interactions and side effects. U.S. Food and Drug Administration
A medicine that was well tolerated at age 55 may therefore need to be reconsidered at age 75 or 85—not necessarily because the medicine has suddenly become “bad,” but because your overall health and medication needs may have changed.
Don’t Stop Your Medicines Suddenly
One of the most important rules is not to stop a prescribed medication just because you read that it can affect the heart.
Some medications protect against heart attack and stroke despite having potential side effects.
Instead, ask your doctor or pharmacist:
- Why am I taking this medication?
- Do I still need it?
- Is the dose appropriate for my age and kidney function?
- Could it raise my blood pressure?
- Does it interact with my other medicines?
- Is there a safer alternative for my particular situation?
A medication review can be especially useful if you take several prescriptions and over-the-counter products.
Final Takeaway
The biggest concern isn’t that five specific medicines are universally dangerous for older people. Rather, certain medications—including NSAIDs, systemic decongestants, and inappropriate or unnecessary aspirin use—can create cardiovascular problems in susceptible people, particularly when used at higher doses, for long periods, or alongside existing heart disease.
The safest approach is to have your complete medication list reviewed regularly. Never stop a prescribed heart or blood-pressure medicine on your own, and always tell your doctor or pharmacist about over-the-counter painkillers, cold medicines, vitamins, and supplements you use. U.S. Food and Drug Administration
