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

The 5 Medication Categories That Require Extra Cardiovascular Caution

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

• Examples: Ibuprofen (Advil, Motrin), Naproxen (Aleve), Celecoxib.
• The Concern: Regular or long-term use of NSAIDs can inhibit protective compounds in the body, leading to elevated blood pressure, fluid retention, and an increased risk of heart attacks, strokes, and heart failure flare-ups—particularly for individuals with pre-existing cardiovascular conditions. They also carry well-known risks for gastrointestinal bleeding and kidney strain.
• Safer Approach: For chronic joint pain, physicians often recommend non-pharmacological therapies (like physical therapy or heat/cold application) or topical NSAID creams (such as Voltaren), which target the painful joint locally with minimal absorption into the bloodstream.

2. Certain Oral Decongestants (Sympathomimetics)

• Examples: Pseudoephedrine (Sudafed), Phenylephrine.
• The Concern: These drugs act as vasoconstrictors, shrinking swollen nasal blood vessels to relieve congestion. However, they constrict blood vessels throughout the entire body as well, which can trigger sudden spikes in blood pressure and accelerate heart rates—posing significant hazards for those managing hypertension or coronary artery disease.
• Safer Approach: Saline nasal sprays, neti pots, or short-term topical medicated nasal sprays (used for strictly limited 3-to-5-day windows) avoid these systemic blood pressure surges.

3. Unmonitored or High-Dose Daily Aspirin (Primary Prevention)

• The Concern: While a daily low-dose aspirin is a proven lifesaver for individuals who have already experienced a heart attack or stroke (secondary prevention), modern cardiology guidelines have shifted away from recommending routine daily aspirin for older adults without a history of cardiovascular disease. The risk of major internal bleeding (particularly in the stomach or brain) often outweighs the preventative benefits in older populations.
• Safer Approach: Never start or stop a daily aspirin regimen on your own. Always review your personalized 10-year cardiovascular risk profile with your doctor or cardiologist.

4. Certain Atypical and Traditional Antipsychotics

• Examples: Quetiapine, Risperidone, Haloperidol.
• The Concern: While occasionally prescribed to manage severe agitation or behavioral symptoms associated with advanced dementia, these medications carry black-box warnings for increased risks of stroke, cardiovascular events, and cardiac arrhythmias in older adults.
• Safer Approach: Non-pharmacological behavioral interventions are always the preferred first-line approach, reserving medications strictly for situations where safety is compromised, under close medical monitoring.

5. Long-Term Systemic Corticosteroids

• Examples: Prednisone, Methylprednisolone.
• The Concern: While short, tapering bursts of steroids are essential for severe asthma flares or acute inflammatory conditions, chronic long-term use can elevate blood pressure, worsen blood sugar control, cause fluid retention, and contribute to arterial plaque buildup over time.
• Safer Approach: Using steroids at the lowest effective dose for the shortest duration possible, followed by a careful medical taper.

Protecting Your Heart: Next Steps

• Never Stop a Medication Abruptly: If you or a loved one are taking any of these medications, never discontinue them without speaking to your physician, as stopping certain drugs abruptly can trigger dangerous rebound effects.
• Request a Medication Review: Bring every prescription, over-the-counter pain reliever, vitamin, and supplement you take to your next doctor’s appointment. A comprehensive “brown bag” medication review is the single best way to catch hidden risks and keep your heart safe.