A Cardiologist Warns: 5 Medication Categories Older Adults Should Review for Heart Attack and Stroke Risk
Medicines can prevent heart attacks, control blood pressure, reduce pain, treat infections, and manage chronic diseases.
But every medication has potential benefits and risks.
For older adults, those risks can become more important because aging can change how the liver and kidneys process medicines, and many older people take several medications at the same time. The FDA notes that these factors can increase the possibility of drug interactions and unwanted effects.
That does not mean seniors should stop medications that have been prescribed for them.
Instead, it means certain medication categories deserve particular attention when someone has cardiovascular disease, high blood pressure, kidney problems, or a history of stroke.
1. Non-Aspirin NSAID Painkillers
Nonsteroidal anti-inflammatory drugs, commonly called NSAIDs, include medicines such as ibuprofen and naproxen.
These medications are widely used for pain and inflammation, but the FDA warns that non-aspirin NSAIDs can increase the risk of serious cardiovascular events, including heart attack and stroke. The risk can occur relatively early during treatment and may increase with higher doses or longer use.
The risk is particularly important for people who already have cardiovascular disease or other risk factors.
NSAIDs can also cause gastrointestinal bleeding and kidney problems, which can be especially significant in older adults.
The important point
Don’t assume that an over-the-counter painkiller is automatically harmless because it doesn’t require a prescription.
If an older person needs pain medicine regularly, it is worth discussing the safest option and dose with a healthcare professional.
2. Decongestants in Some Cold Medicines
Cold and allergy products sometimes contain decongestants such as pseudoephedrine or phenylephrine.
These medicines can constrict blood vessels and may raise blood pressure and heart rate.
The American Heart Association notes that decongestants can be particularly concerning for people with high blood pressure or heart disease.
The FDA similarly advises people with heart disease or high blood pressure to ask a healthcare professional before using nasal decongestants.
This is easy to overlook because the medication may be purchased as an ordinary cold remedy.
Check combination products
A single cold-and-flu product may contain several active ingredients.
Always read the label rather than assuming that a product is simply a cough or cold medicine.
3. Some Stimulant-Containing Medicines
Certain medicines that stimulate the cardiovascular system can increase heart rate or blood pressure.
For example, FDA labeling for some bronchodilator products warns that increased blood pressure or heart rate can increase cardiovascular risk, particularly in people with heart disease or high blood pressure and when products are taken more frequently or at higher-than-recommended doses.
This doesn’t mean that someone who needs a prescribed inhaler should stop using it.
The correct treatment depends on the specific medicine and the condition being treated.
The important lesson is to use these medicines exactly as directed and discuss cardiovascular conditions with the prescribing professional.
4. Certain JAK Inhibitors
Some medicines known as JAK inhibitors are used to treat inflammatory and autoimmune conditions.
The FDA requires boxed warnings for certain JAK inhibitors because clinical-trial evidence identified increased risks of serious heart-related events, cancer, blood clots, and death in particular populations. The risk was especially concerning in people who were current or former smokers and those with certain cardiovascular risk factors.
This is a good example of why medication risk cannot be reduced to a simple “safe” or “dangerous” label.
These medicines can provide important benefits for people with serious inflammatory diseases.
A doctor weighs those benefits against the individual’s risks.
5. Aspirin — But This One Is More Complicated
Aspirin deserves special attention because it can actually reduce the risk of heart attack and clot-related stroke in certain people, particularly people with established cardiovascular disease.
At the same time, aspirin increases the risk of serious bleeding, including bleeding in the brain and gastrointestinal bleeding.
Therefore, aspirin should not simply be placed in a category of medicines that “cause heart attacks and strokes.”
The issue is who should take it and why.
For someone who has already had a heart attack or certain types of stroke, aspirin may be an important part of treatment.
For someone without established cardiovascular disease, routine aspirin use may provide little benefit while increasing bleeding risk.
The FDA recommends discussing regular aspirin therapy with a healthcare professional rather than starting it independently.
Why Older Adults Need Extra Medication Reviews
As people age, several things can change simultaneously.
Kidney and liver function may decline, medications may remain in the body longer, and the number of prescriptions and over-the-counter products may increase.
The result is a greater possibility of interactions.
One medicine can also affect how another medicine works.
That’s why medication reviews are especially valuable for older adults.
Don’t Forget Over-the-Counter Medicines
A common mistake is to tell a doctor about prescription medications but forget to mention products bought from a pharmacy or supermarket.
These can include:
- Pain relievers
- Cold medicines
- Allergy medicines
- Antacids
- Vitamins
- Herbal supplements
- Sleep products
The FDA recommends keeping healthcare professionals informed about medicines, supplements, and other products being used.
Never Stop a Prescription Suddenly
This may be the most important message in the entire article.
Reading that a medication can affect cardiovascular risk does not mean you should stop taking it.
Some medicines can cause serious problems if stopped abruptly.
Instead, ask a doctor or pharmacist:
“Is this medication still appropriate for me, given my age, heart health, blood pressure, kidney function, and other medicines?”
That question can lead to a much safer medication review than simply stopping treatment.
Recognize Heart Attack and Stroke Warning Signs
Medication safety is important, but recognizing emergencies is just as important.
Possible heart attack symptoms can include chest pressure or pain, shortness of breath, unusual sweating, nausea, or discomfort spreading to the arm, shoulder, back, neck, or jaw.
Stroke symptoms can appear suddenly and may include:
- Facial drooping
- Weakness or numbness, especially on one side
- Trouble speaking or understanding speech
- Sudden vision problems
- Sudden difficulty walking or loss of balance
- A sudden severe headache in some cases
A suspected heart attack or stroke requires emergency medical attention.
Don’t wait to see whether symptoms disappear.
The Bottom Line
There isn’t a universal list of “five medications that seniors should never take.”
Some medicines can increase cardiovascular risk in particular circumstances, while others can actually reduce the risk of heart attack or stroke when appropriately prescribed.
Important categories to review include non-aspirin NSAIDs, certain decongestants, some stimulant-containing medicines, certain JAK inhibitors, and aspirin when used without an appropriate medical indication. The actual risk depends on the medication, dose, duration, medical history, and other treatments.
For older adults, the safest approach isn’t fear.
It’s regular medication review.
Never stop a prescribed medicine because of an alarming headline. Instead, have a doctor or pharmacist review the complete medication list—including over-the-counter medicines and supplements—to determine what should be continued, changed, or avoided.
