A Cardiologist Warns: 5 Medication Groups Older Adults Should Review for Heart Attack and Stroke Risk
Many older adults rely on medication to manage pain, arthritis, high blood pressure, breathing problems, or other chronic conditions. These treatments can be essential for maintaining health and independence. However, certain medications may raise blood pressure, affect circulation, or increase the risk of cardiovascular complications in some people.
The concern is not that all these medications are dangerous. Rather, age, existing heart disease, dosage, duration of use, and interactions with other medicines can change the balance between benefits and risks.
Understanding which medications deserve extra attention can help you have a more informed conversation with your doctor or pharmacist.
Here are five medication groups worth reviewing, particularly if you are over 65 or have a history of heart disease, stroke, or high blood pressure.
1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Common examples include ibuprofen, naproxen, and certain prescription anti-inflammatory medicines.
NSAIDs are widely used to relieve arthritis pain, headaches, muscle aches, and inflammation. Although they can be effective, they carry an important cardiovascular warning.
The U.S. Food and Drug Administration warns that non-aspirin NSAIDs can increase the risk of heart attack and stroke. The risk may begin within the first weeks of use and can increase with higher doses or longer treatment. NSAIDs may also cause fluid retention and raise blood pressure.
Why can they be concerning?
These medicines can affect kidney function and the body’s handling of sodium and water. In some people, this can increase blood pressure, worsen heart failure, or interfere with certain blood pressure medications.
The risks may be greater in people who already have cardiovascular disease or other relevant health conditions.
What should older adults do?
- Ask a healthcare professional before using NSAIDs regularly.
- Use the lowest effective dose for the shortest appropriate period, as advised.
- Tell your doctor if you have heart disease, high blood pressure, kidney problems, or a history of stomach bleeding.
- Do not assume that an over-the-counter pain reliever is automatically safe.
Do not stop prescribed treatment without discussing a safe alternative with your healthcare professional.
2. Decongestants Found in Cold and Flu Medicines
Some cold and allergy medications contain decongestants such as pseudoephedrine or phenylephrine.
These ingredients help relieve a blocked nose by narrowing blood vessels. However, this action can also increase blood pressure in some people and may affect heart rate.
Why can they be concerning?
Older adults with uncontrolled hypertension, coronary artery disease, or certain heart rhythm problems may be more vulnerable to unwanted cardiovascular effects.
Decongestants can also interact with other medicines, and combination cold remedies may contain ingredients that are easy to overlook.
What should older adults do?
- Check the active ingredients on cold and flu medicine labels.
- Ask a pharmacist whether a product is suitable if you have high blood pressure or heart disease.
- Discuss alternatives, such as saline nasal sprays, when appropriate.
- Avoid combining multiple cold remedies without checking their ingredients.
A decongestant is not automatically dangerous for every older adult, but people with cardiovascular conditions should take extra care.
3. Oral Corticosteroids Such as Prednisone
Corticosteroids are prescribed to reduce inflammation and treat conditions such as severe asthma, certain autoimmune diseases, and inflammatory disorders.
Examples include prednisone and prednisolone.
These medications can be very beneficial when appropriately prescribed. However, systemic corticosteroids may increase blood pressure, contribute to fluid retention, and raise blood glucose levels.
Why can they be concerning?
These effects may place additional strain on people with existing cardiovascular disease, diabetes, kidney problems, or heart failure.
The degree of risk depends on factors such as the dose, duration of treatment, and individual health.
Long-term use can have different risks from a short, medically necessary course.
What should older adults do?
- Take corticosteroids exactly as prescribed.
- Ask about blood pressure and blood glucose monitoring when appropriate.
- Report new swelling, rapid unexplained weight gain, or worsening breathlessness.
- Never stop long-term corticosteroid treatment suddenly without medical guidance, because abrupt withdrawal can be dangerous.
Your doctor can help determine whether the benefits of treatment outweigh its risks and whether monitoring or adjustments are needed.
4. Certain Antipsychotic Medications
Antipsychotic medicines may be prescribed for conditions such as schizophrenia, bipolar disorder, and, in selected circumstances, severe behavioral symptoms associated with dementia.
Examples include risperidone, quetiapine, and olanzapine.
These medications are not interchangeable, and their risks vary depending on the drug, dose, reason for treatment, and the person’s health.
Why can they be concerning?
Some antipsychotics can contribute to metabolic changes, including weight gain, elevated blood glucose, and lipid abnormalities. Certain medications can also affect heart rhythm or blood pressure.
There is an additional important warning for older adults with dementia: antipsychotics carry a boxed warning in the United States concerning increased mortality in this population, and some have been associated with an increased risk of stroke in older adults with dementia-related psychosis.
This does not mean that everyone taking an antipsychotic will experience a cardiovascular event. It does mean that the reason for treatment and the expected benefits should be carefully reviewed.
What should older adults and caregivers do?
- Ask the prescriber to explain the expected benefits and possible risks.
- Review whether the medication remains necessary during regular appointments.
- Report fainting, palpitations, or significant changes in alertness.
- Do not stop an antipsychotic abruptly without medical advice.
For people with serious psychiatric conditions, these medicines may be important. Decisions about treatment should be individualized rather than based on a general warning.
5. Certain Cancer Treatments That Can Affect Blood Vessels
Some cancer treatments, particularly certain targeted therapies that inhibit blood vessel growth, can cause high blood pressure or increase the risk of arterial cardiovascular complications.
The specific risks depend heavily on the medication and the type of cancer being treated.
Why can they be concerning?
Some of these treatments can raise blood pressure significantly. Certain medicines may also increase the risk of arterial events, including heart attack or stroke, in susceptible patients.
Because cancer treatment can be lifesaving, stopping a medication without specialist guidance may carry substantial risks of its own.
What should patients do?
- Follow the monitoring plan provided by the oncology team.
- Check blood pressure as directed.
- Report new chest discomfort, unusual breathlessness, severe headaches, or neurological symptoms promptly.
- Ask the oncologist about cardiovascular monitoring and how other medications may interact with treatment.
Older adults receiving cancer treatment may benefit from coordinated care between their oncologist, primary care clinician, and cardiologist when appropriate.
Warning Signs of a Heart Attack or Stroke
Knowing the symptoms of a cardiovascular emergency is just as important as reviewing medication risks.
Possible heart attack symptoms include:
- Chest pressure, squeezing, or discomfort
- Pain or discomfort in the arm, back, neck, jaw, or upper abdomen
- Shortness of breath
- Cold sweats, nausea, or sudden unusual weakness
Possible stroke symptoms include:
- Sudden weakness or numbness, especially on one side of the body
- Sudden difficulty speaking or understanding speech
- Sudden loss of vision or double vision
- Sudden difficulty walking, dizziness, or loss of balance
- A sudden severe headache without an obvious cause
Symptoms can vary, especially in older adults. If a heart attack or stroke is suspected, call your local emergency number immediately. Do not wait to see whether symptoms improve.
How Older Adults Can Use Medication More Safely
Medication safety is about balancing benefits and risks—not avoiding every medicine that has a warning.
A few practical steps can make a meaningful difference:
- Keep an updated medication list. Include prescriptions, over-the-counter products, vitamins, and supplements.
- Review medicines regularly. Ask your doctor or pharmacist whether each medication is still necessary and appropriate.
- Check before taking new over-the-counter products. Cold remedies and pain relievers can affect blood pressure or interact with prescribed treatments.
- Monitor relevant health measurements. Follow professional advice about blood pressure, glucose, kidney function, or heart rhythm monitoring.
- Ask about alternatives. If a medicine poses a concern, a healthcare professional may be able to recommend a safer option for your circumstances.
Never stop heart medication, blood pressure treatment, or another prescribed medicine simply because you have read that it may carry a risk. Some medications substantially reduce the risk of heart attack and stroke when used appropriately.
The Bottom Line
Certain NSAIDs, decongestants, oral corticosteroids, antipsychotics, and specific cancer treatments can affect cardiovascular health in some patients. However, the evidence and the type of risk differ considerably between medication groups.
The most important step is to review your own medication list with a qualified healthcare professional, especially if you are older, have heart disease, or take several medicines.
The goal is not to create fear about medication. It is to make sure every treatment is appropriate, monitored when necessary, and providing more benefit than harm.
Medical disclaimer: This article is for educational purposes only and is not a substitute for personalized medical advice, diagnosis, or treatment.
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