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

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

• Common Examples: Ibuprofen (Advil, Motrin), Naproxen (Aleve), Diclofenac, and high-dose Celecoxib.
• The Cardiovascular Risk: NSAIDs are among the most scrutinized medications by cardiologists. They inhibit hormone-like substances called prostaglandins, which can lead to sodium and water retention, increased blood pressure, and a heightened tendency for blood platelets to clump together. In older adults—who may already have subclinical plaque buildup or arterial stiffness—regular or high-dose NSAID use significantly raises the risk of heart attacks, strokes, and worsening heart failure.
• Safer Approach: For occasional aches, alternatives like acetaminophen are often recommended because they do not carry these vascular risks (though they have liver limits). If an NSAID is necessary for chronic arthritis, doctors aim for the lowest effective dose for the shortest duration possible.

2. Certain Oral Decongestants

• Common Examples: Pseudoephedrine and Phenylephrine (frequently found in over-the-counter cold, flu, and sinus medications).
• The Cardiovascular Risk: Decongestants work by causing vasoconstriction—shrinking blood vessels in the nasal passages to relieve congestion. However, they don’t just target the nose; they narrow blood vessels systemically. This can cause acute spikes in blood pressure and force the heart to work much harder, posing a direct threat to older adults with hypertension or underlying coronary artery disease.
• Safer Approach: Saline nasal sprays, humidifiers, or topical vapor rubs offer drug-free relief without systemic cardiovascular side effects.

3. Prescription Stimulants and Certain ADHD Medications

• Common Examples: Methylphenidate and Amphetamine-based formulations.
• The Cardiovascular Risk: While commonly associated with younger populations, stimulants are occasionally prescribed to older adults for treatment-resistant apathy, fatigue, or cognitive slowing. Because these drugs stimulate the central nervous system, they consistently elevate heart rate and blood pressure, which can strain aging heart muscles and provoke arrhythmias or ischemic events in susceptible individuals.
• Safer Approach: Rigorous baseline cardiac screening (including an ECG and blood pressure monitoring) is vital before any stimulant therapy is considered in older age.

4. Certain Antipsychotic Medications (Atypical and Typical)

• Common Examples: Risperidone, Quetiapine, Olanzapine, Haloperidol.
• The Cardiovascular Risk: Though frequently used off-label or on-label to manage severe agitation, anxiety, or psychosis associated with advanced dementia, these medications carry black-box warnings for older adults. They have been linked to an increased risk of stroke, sudden cardiac death, and dangerous heart rhythm abnormalities (such as QT prolongation).
• Safer Approach: Non-pharmacological behavioral interventions and environmental modifications are heavily favored as first-line approaches for managing behavioral shifts in dementia, reserving medications strictly for situations where safety is compromised.

5. High-Dose Corticosteroids

• Common Examples: Prednisone, Methylprednisolone, Dexamethasone.
• The Cardiovascular Risk: Short bursts of steroids are invaluable for severe inflammatory flares or asthma exacerbations, but long-term or recurring use in older adults carries heavy metabolic tolls. Corticosteroids frequently elevate blood pressure, worsen blood glucose control (pushing patients toward diabetes), cause fluid retention, and accelerate atherosclerosis over time—all of which multiply the long-term risk of heart attacks and strokes.
• Safer Approach: Doctors carefully taper steroids down to the lowest possible maintenance dose or transition patients to localized steroid therapies (like inhalers or joint injections) to minimize systemic exposure.

Protecting Your Heart Health