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

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

• The Drugs: Ibuprofen (Advil, Motrin), naproxen (Aleve), and prescription-strength options like diclofenac or celecoxib.
• Why it’s a risk: Widely used for arthritis and joint pain, traditional NSAIDs inhibit prostaglandins, which can cause fluid retention, raise blood pressure, and constrict blood vessels. Regular, long-term use significantly spikes the risk of heart attacks and strokes, even in people without prior heart disease.
• The Safer Alternative: For occasional aches, topical NSAID gels (like diclofenac sodium topical gel) deliver pain relief locally to a joint with much lower systemic absorption into the bloodstream. Non-drug options like physical therapy or heat packs are also great first lines of defense.

2. Decongestants Containing Pseudoephedrine or Phenylephrine

• The Drugs: Over-the-counter cold, sinus, and allergy medications (often labeled with a “D” at the end, like Claritin-D or Sudafed).
• Why it’s a risk: Decongestants work by constricting blood vessels to clear up swollen nasal passages. However, they don’t just target your nose—they constrict blood vessels systemically, forcing the heart to pump harder against higher resistance and causing sharp spikes in blood pressure and rapid heart rates. For an older adult with underlying hypertension, this can trigger a cardiac event.
• The Safer Alternative: Saline nasal sprays, humidifiers, or steam inhalation can clear congestion safely without touching your cardiovascular system.

3. Certain Atypical and Typical Antipsychotic Medications

• The Drugs: Medications such as quetiapine, risperidone, or haloperidol, sometimes prescribed off-label or for managing severe agitation, behavioral symptoms of dementia, or psychiatric conditions in older adults.
• Why it’s a risk: Extensive clinical safety warnings highlight that antipsychotics used in elderly populations are linked to a significantly elevated risk of strokes, sudden cardiac death, and dangerous heart rhythm irregularities (arrhythmias).
• The Safer Alternative: When used for behavioral symptoms related to dementia, non-pharmacological approaches (environmental calming, routine structuring) are heavily favored by geriatric specialists before turning to psychotropic drugs.

4. Proton Pump Inhibitors (PPIs) Used Long-Term

• The Drugs: Omeprazole (Prilosec), esomeprazole (Nexium), and lansoprazole (Prevacid) used chronically for acid reflux or GERD.
• Why it’s a risk: While fantastic for healing the stomach lining short-term, decades of observational data suggest that chronic, uninterrupted use of high-dose PPIs can impair endothelial function (the health and flexibility of your blood vessels), alter nutrient absorption, and modestly increase long-term cardiovascular risks and kidney stress in older adults.
• The Safer Alternative: Lifestyle management of acid reflux—such as avoiding late-night eating, elevating the head of the bed, and using short-term antacids—can sometimes reduce the need for daily, lifelong PPI dependency under a doctor’s guidance.

5. Corticosteroids (Oral Steroids)

• The Drugs: Prednisone, methylprednisolone, or dexamethasone taken orally for flare-ups of conditions like COPD, severe arthritis, or asthma.
• Why it’s a risk: Short bursts are usually well-tolerated, but chronic or repeated courses of oral steroids cause rapid fluid retention, spikes in blood sugar, weight gain, and significant increases in blood pressure—all of which place heavy, cumulative stress on an aging heart and raise stroke risks.
• The Safer Alternative: Doctors try to use inhaled or localized steroid formulations (like inhalers or joint injections) whenever possible to minimize the systemic cardiovascular impact of oral pills.

⚠️ A Crucial Note on Polypharmacy:

Older adults are frequently prescribed multiple medications by different specialists. When combined, certain drug interactions can exponentially multiply cardiovascular side effects. Never stop a prescribed medication abruptly on your own; instead, schedule a regular “brown bag” medication review with your primary care physician or geriatric pharmacist to ensure your regimen is as heart-safe as possible.