Some medications can be associated with a higher risk of heart attack or stroke in older adults, but the risk usually depends on the person’s medical history, dose, drug interactions, and whether the medication is appropriately prescribed. A blanket warning that certain medicines “cause heart attacks and strokes” can be misleading.
Five medication categories that doctors often review carefully in older adults because they may increase cardiovascular risk in certain situations include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
Examples: ibuprofen and naproxen- May raise blood pressure, cause fluid retention, and increase the risk of heart attack or stroke, especially with long-term use or in people with heart disease.
- Certain diabetes medications (especially older agents or those causing low blood sugar)
- Severe low blood sugar episodes can strain the heart and may increase cardiovascular risk in vulnerable older adults. Medication choice depends heavily on the individual.
- Some antipsychotic medications
- Certain antipsychotics have been linked to increased risk of stroke and death in older adults with dementia-related psychosis.
- Hormonal medications (in some older adults)
Examples: some forms of estrogen therapy- Depending on age, timing, dose, and health history, some hormone therapies may increase risks of blood clots, stroke, or cardiovascular events.
- Stimulant medications or certain decongestants
Examples: pseudoephedrine-containing cold medicines- Can raise heart rate and blood pressure, which may be risky for people with hypertension, arrhythmias, or heart disease.
Older adults should be especially cautious about:
- Starting new medicines without reviewing all current prescriptions
- Combining over-the-counter pain or cold medicines with heart medications
- Ignoring new chest pain, shortness of breath, sudden weakness, facial drooping, or speech difficulty (possible heart attack or stroke symptoms)
If you have a specific list of medications (including over-the-counter pills and supplements), I can help flag which ones commonly require heart-risk monitoring in older adults.
