A cardiologist warns: these 5 medications increase the risk of heart attack and stroke in older people

1. Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

• Common Examples: Ibuprofen (Advil, Motrin), Naproxen (Aleve), and prescription-strength COX-2 inhibitors (like celecoxib).
• The Cardiovascular Risk: While widely used for arthritis and joint pain, regular or high-dose NSAID use can cause fluid retention, raise blood pressure, and cause blood vessels to constrict. More critically, they can tip the balance of blood clotting factors, increasing the risk of heart attacks and strokes—particularly in older adults with pre-existing cardiovascular disease.
• Safer Alternatives: Healthcare providers often recommend topical anti-inflammatory gels (which limit systemic absorption), acetaminophen for mild pain, or physical therapy.

2. Certain Decongestants (Sympathomimetics)

• Common Examples: Pseudoephedrine and phenylephrine (found in many over-the-counter cold, flu, and sinus medications).
• The Cardiovascular Risk: Decongestants work by stimulating alpha-adrenergic receptors, which constrict blood vessels to reduce nasal swelling. However, this vessel-constricting action also raises systemic blood pressure and increases heart rate. In older adults—especially those with hypertension or coronary artery disease—this can place acute stress on the heart muscle.
• Safer Alternatives: Saline nasal sprays, humidifiers, or non-medicated vapor strips.

3. Hormonal Therapies (Estrogen and Progestin)

• Common Examples: Hormone Replacement Therapy (HRT) used to manage menopausal symptoms.
• The Cardiovascular Risk: While HRT can be beneficial for younger women nearing menopause, initiating or continuing systemic hormone therapy in older women (particularly years past menopause) has been linked in major clinical trials to an increased risk of blood clots, deep vein thrombosis (DVT), stroke, and heart attack.
• Safer Alternatives: Low-dose non-hormonal treatments or localized treatments discussed with a gynecologist or primary care physician.

4. Certain Atypical Antipsychotics

• Common Examples: Risperidone, quetiapine, and olanzapine (sometimes prescribed to manage behavioral symptoms associated with dementia or severe agitation in older adults).
• The Cardiovascular Risk: Clinical studies have shown that certain antipsychotic medications carry an elevated risk of stroke, sudden cardiac death, and arrhythmias in elderly patients—particularly those with underlying cerebrovascular disease or dementia.
• Safer Alternatives: Non-pharmacological behavioral management strategies and environmental adjustments supervised by geriatric specialists.

5. High-Dose Corticosteroids

• Common Examples: Prednisone, methylprednisolone, and dexamethasone (used for severe inflammatory conditions, asthma flares, or autoimmune disorders).
• The Cardiovascular Risk: Long-term or frequent systemic use of corticosteroids can lead to weight gain, elevated blood sugar (insulin resistance), fluid retention, and hypertension—all of which are major risk factors that strain the cardiovascular system over time and increase stroke and heart attack risk.
• Safer Alternatives: Shortest possible treatment courses, tapering schedules, or localized steroid injections when appropriate.

Why Medication Reviews Are Vital for Older Adults