A Cardiologist Warns: 5 Medications That Can Raise Heart Attack or Stroke Risk in Older Adults

Some common medicines can raise cardiovascular risks in older adults. Learn which drug categories matter, who is most vulnerable, and what to ask your doctor.

A medicine can be helpful for one part of your health while creating a new concern somewhere else.

That doesn’t mean the medication is “bad.” It means the balance between benefit and risk can change as you get older—especially if you have high blood pressure, kidney disease, diabetes, heart disease, or a history of stroke.

And there’s another problem: some of the medications worth reviewing aren’t prescription drugs sitting in a pharmacy bottle. They may be common over-the-counter products for pain, congestion, or other everyday symptoms.

The U.S. Food and Drug Administration notes that older adults are more likely to take multiple medicines and that age-related changes in the liver, kidneys, and body composition can alter how medications are handled. Those factors can increase the possibility of side effects and drug interactions.

So which medications deserve particular attention?

There isn’t a medically accurate list of five drugs that every older person should stop taking. Instead, several medication categories have cardiovascular warnings or important interactions that become especially relevant when someone already has cardiovascular risk factors.

Here are five worth knowing about—and what you should do if one is already part of your routine.

First, an important warning: don’t stop a prescribed medication on your own

Before getting into the list, there’s one rule that matters more than anything else in this article:

Do not suddenly stop a prescription medication because you read that it may affect the heart or blood vessels.

Some medications are essential for preventing heart attacks, strokes, seizures, blood clots, or other serious problems. Stopping them abruptly can sometimes be more dangerous than continuing them.

The FDA specifically advises older adults not to skip doses or stop prescribed medicines without first talking with a health professional.

The goal isn’t to create fear.

It’s to help you recognize medications that may deserve a medication review.

1. Non-Aspirin NSAIDs: Common Painkillers With a Cardiovascular Warning

This is probably the most important category to recognize because many people don’t think of over-the-counter pain medicine as something that can affect the heart.

NSAIDs—or nonsteroidal anti-inflammatory drugs—include familiar medications such as ibuprofen and naproxen, as well as several prescription drugs.

They’re widely used for arthritis, back pain, muscle aches, headaches, and other painful conditions.

But non-aspirin NSAIDs carry an FDA warning about increased risk of serious cardiovascular events, including heart attack and stroke. The FDA says the risk can occur early in treatment and may increase with higher doses and longer use.

That doesn’t mean an older adult can never take an NSAID.

It means the decision deserves more thought if you’re already at elevated cardiovascular risk.

Why can NSAIDs affect the cardiovascular system?

NSAIDs work partly by reducing substances involved in inflammation and pain.

Those same pathways are also involved in kidney function, blood pressure regulation, and platelet activity.

In some people, NSAIDs can contribute to fluid retention or higher blood pressure. They can also affect kidney function.

For someone with existing cardiovascular disease, those effects can matter.

The American Heart Association has highlighted concerns about prolonged NSAID use in people with coronary disease, including cardiovascular complications and increased bleeding risk when NSAIDs are combined with blood-thinning medications.

Who should be especially cautious?

Talk with a healthcare professional before using NSAIDs regularly if you have:

Heart disease
High blood pressure
Kidney disease
A previous heart attack
A previous stroke
Heart failure
A history of gastrointestinal bleeding
Multiple medications, particularly blood thinners

And remember that some cold, flu, and combination products contain NSAIDs.

You can accidentally take more than one NSAID without realizing it.

The FDA specifically advises consumers to read labels because NSAIDs can be included in multiple over-the-counter products.

2. Oral Decongestants: The Cold Medicine People Often Forget About

A stuffy nose seems harmless.

That’s why people may not think twice before reaching for a decongestant.

But some oral or nasal decongestants can affect blood pressure and heart rate.

The FDA advises people with heart disease or high blood pressure to ask a doctor before using nasal decongestants.

This doesn’t mean every decongestant will cause a heart attack or stroke.

The concern is that certain decongestants can stimulate the cardiovascular system, potentially increasing blood pressure or heart rate in susceptible people.

For a healthy younger person, a short course may be reasonable.

For an older adult with poorly controlled hypertension or significant cardiovascular disease, the same product may deserve more caution.

The hidden problem: combination cold medicines

This is where label-reading becomes important.

A single “cold and flu” product may contain several active ingredients.

You might be treating congestion, cough, fever, and pain with one package—but you need to know what is actually inside it.

That’s especially important when you’re already taking prescription medications.

The FDA emphasizes that drug interactions can occur between medications, supplements, foods, and existing medical conditions.

A better question to ask

Instead of asking:

“Is this cold medicine safe?”

Ask:

“Which active ingredient is responsible for the congestion relief, and is that ingredient appropriate for my blood pressure and heart condition?”

That question is much more useful.

3. Stimulant Medications: When Raising Alertness Can Also Affect the Heart

Certain prescription stimulant medications affect the sympathetic nervous system and can increase heart rate or blood pressure.

They’re used for conditions such as ADHD and certain other medical indications.

These medications aren’t automatically inappropriate for older adults.

But cardiovascular history matters.

If someone has significant heart disease, uncontrolled hypertension, an abnormal heart rhythm, or other cardiovascular concerns, the prescribing clinician may need to consider the potential risks carefully.

This is particularly relevant because older adults are more likely to have multiple chronic conditions and multiple medications at the same time.

The FDA explains that aging can alter how medicines are absorbed, processed, and eliminated, while drug-drug and drug-condition interactions can become more important.

The point isn’t “stimulants are dangerous”

That’s too broad.

The better takeaway is:

A medication that increases cardiovascular stimulation deserves individualized assessment in someone with cardiovascular disease.

That assessment may include blood-pressure monitoring, reviewing other medicines, and considering whether the medication remains necessary at the current dose.

Never change the dose yourself.

4. Some Antipsychotic Medications: A Special Concern in Older Adults With Dementia

This category requires particularly careful wording.

Certain antipsychotic medications carry an FDA boxed warning regarding increased mortality in elderly patients with dementia-related psychosis.

The concern is not simply that these drugs “cause heart attacks.”

The broader safety issue includes cardiovascular and cerebrovascular events, among other serious risks.

That distinction matters.

Antipsychotics can be appropriate for specific medical situations, and abruptly stopping some psychiatric medications can cause problems.

But when an older adult with dementia is taking one, the prescribing team should periodically reassess whether the medication is still necessary, whether the dose is appropriate, and whether the expected benefit outweighs the risks.

This is a classic example of why a medication should never be judged from a headline alone.

A drug may be inappropriate for one person but reasonable for another.

5. Erythropoiesis-Stimulating Agents: An Often-Overlooked Cardiovascular Risk

This category is less familiar to the general public but important in certain patients.

Erythropoiesis-stimulating agents, or ESAs, are medications used in particular situations to stimulate red blood cell production.

They can be prescribed for some people with anemia associated with chronic kidney disease and for certain cancer-related circumstances.

The reason they deserve careful monitoring is that increasing hemoglobin too aggressively in some patients has been associated with cardiovascular and stroke risks.

This isn’t a medication most healthy older adults will encounter.

But for someone with chronic kidney disease or cancer-related anemia, it can be an important part of treatment.

The lesson is broader than the drug itself:

Correcting anemia isn’t automatically safer when the hemoglobin is pushed higher and higher.

Treatment targets matter.

The patient’s underlying condition matters.

And monitoring matters.

Why Older Adults Can Be More Vulnerable

Age itself doesn’t mean medication becomes dangerous.

But aging changes the way the body handles many drugs.

The FDA notes that kidney and liver function can decline with age, affecting how medications are broken down and removed from the body. Changes in body weight and circulation can also alter drug exposure.

Then there’s the issue of polypharmacy.

One person might take medication for:

Blood pressure
Cholesterol
Arthritis
Diabetes
Sleep
Acid reflux
Depression
Allergies
Heart rhythm
Blood clots

Each medication might have a reasonable purpose.

The challenge is what happens when they interact.

That’s why medication review becomes increasingly valuable with age.

The Medication List You Keep in Your Wallet Could Matter More Than You Think

If you have ever visited an emergency department, changed doctors, or been admitted to a hospital, you’ve probably been asked:

“What medications are you taking?”

That question isn’t paperwork for paperwork’s sake.

It’s clinically important.

Your medication list should ideally include:

Prescription medications
Over-the-counter pain relievers
Cold medicines
Vitamins
Herbal supplements
Sleep aids
Topical medications when relevant
The dose
How often you take each product

The FDA recommends telling healthcare professionals about all medications and supplements you use, even products you take only occasionally.

A forgotten bottle of ibuprofen can be relevant.

So can an occasional aspirin-containing product.

The Biggest Mistake: Thinking “Over the Counter” Means “Risk Free”

This is one of the most persistent medication misconceptions.

Over-the-counter doesn’t mean harmless.

It means the medication is available without a prescription under specified conditions.

Some OTC medicines can affect blood pressure, the kidneys, bleeding risk, heart rhythm, or interactions with prescription drugs.

NSAIDs are an obvious example.

So are some decongestants.

And older adults may have more medical conditions that make these effects important.

What About Aspirin? Is It on the List?

This is where headlines can become dangerous.

Aspirin is not simply a “bad heart medication.”

For certain people who already have cardiovascular disease or have previously experienced a heart attack or stroke, aspirin may be prescribed to reduce the risk of another cardiovascular event.

The FDA notes that aspirin can reduce the risk of heart attack and clot-related stroke in people with cardiovascular disease or a prior event.

But aspirin also increases bleeding risk.

And taking daily aspirin simply because you’re older—or because a friend takes it—is not necessarily appropriate.

The FDA specifically warns against starting long-term daily aspirin for prevention without guidance from a healthcare professional.

So if you’re already taking prescribed aspirin, don’t stop it because of this article.

Ask your clinician whether it remains appropriate for you.

What About Blood Thinners?

Blood thinners deserve similar nuance.

Medications such as anticoagulants can be lifesaving for people with conditions such as atrial fibrillation or certain blood clots.

They aren’t medications you should stop simply because you’re worried about bleeding.

The bigger issue is interaction.

For example, adding aspirin or an NSAID without professional guidance can increase bleeding risk.

The FDA notes that older adults should be particularly aware of medication interactions and that some combinations can produce dangerous effects.

The right question isn’t:

“Which medicine is dangerous?”

It’s:

“Is my entire medication combination appropriate for my current health?”

Why Medication Reviews Become More Important After 60

Think of medication management as maintaining a complicated machine.

A medicine that was appropriate five years ago may still be appropriate.

But your health may have changed.

Your kidney function may have changed.

You may have developed high blood pressure.

Another doctor may have added a prescription.

You may now be taking an over-the-counter product that you weren’t taking before.

That’s why medication reviews should be ongoing.

The FDA explicitly notes that medicines that worked well earlier in life may need to be adjusted or changed as people age.

A Simple Step-by-Step Medication Safety Check

You don’t need to memorize every drug interaction.

Instead, use a simple system.

Step 1: Gather everything

Put all prescription medicines, OTC medicines, supplements, and occasional products on the table.

Include the bottle you take “only when your back hurts.”

Include the cold medicine you use twice a year.

Include supplements.

Step 2: Record the dose

Write down how much you take and how often.

Step 3: Identify duplicates

Are two products containing the same active ingredient?

This is surprisingly easy to miss with combination cold and pain medicines.

Step 4: Ask about cardiovascular effects

For each medication, ask:

Could this raise blood pressure, affect heart rhythm, increase fluid retention, or increase bleeding risk?

Step 5: Ask about kidney function

Some medications become more complicated when kidney function declines.

Step 6: Ask what can be stopped

But let your healthcare professional make that decision.

Don’t abruptly discontinue prescriptions.

Step 7: Recheck after major health changes

A hospitalization, new diagnosis, kidney-function change, or new prescription is a good reason to review the entire medication list.

A Real-World Example

Imagine a 72-year-old man with high blood pressure and coronary artery disease.

He takes his prescribed heart medications every morning.

One winter, his knee arthritis becomes painful, so he begins taking an over-the-counter NSAID every day.

A few weeks later, he develops worsening blood pressure control.

The problem isn’t necessarily that the pain medication was “toxic.”

The issue is that the medication may have introduced a new cardiovascular concern into an already complicated situation.

His doctor reviews the medication list and considers alternatives.

That’s what good medication management looks like.

It’s not about fear.

It’s about context.

What You Can Ask Your Doctor or Pharmacist

If you’re over 60 and take several medications, these questions are useful:

Do any of my medications raise cardiovascular risk?
Could any of them increase my blood pressure?
Are any of my medicines hard on the kidneys?
Am I taking more than one product containing an NSAID?
Could any OTC medicine interfere with my prescriptions?
Do I still need every medication on this list?
Are the doses still appropriate for my age and kidney function?
Should I avoid any particular cold or pain medicines?
Does any medication increase my bleeding risk?
When should my medication list be reviewed again?

A pharmacist can also be an excellent resource for checking interactions.

Signs That Require Emergency Attention

Medication questions are important, but certain symptoms should never wait for a routine appointment.

Seek emergency medical attention for symptoms such as:

New or severe chest pain
Trouble breathing
Sudden weakness or numbness, particularly on one side
Sudden difficulty speaking
Sudden confusion
Sudden severe dizziness or loss of balance
Fainting with concerning symptoms

The FDA specifically identifies chest pain, difficulty breathing, sudden weakness or numbness, and sudden slurred speech among symptoms requiring immediate medical attention when cardiovascular complications are suspected.

Don’t wait to see whether the symptoms disappear.

Common Medication Mistakes Older Adults Make

Mistake #1: Taking an OTC painkiller every day without mentioning it

Fix: Put every OTC medication on your medication list.

Mistake #2: Assuming natural supplements can’t interact

Fix: Tell your healthcare professional about supplements just as you would prescription medicines.

Mistake #3: Stopping a medication after reading a scary headline

Fix: Discuss the specific medication and your personal risk with your clinician.

Mistake #4: Using multiple cold products

Fix: Read the active ingredients and avoid duplicating ingredients.

Mistake #5: Forgetting that health conditions change

Fix: Have your medication list reviewed periodically.

Mistake #6: Borrowing someone else’s prescription

Fix: Never take another person’s prescription medication unless it has been prescribed specifically for you.

The Pros and Cons of a Medication Review

Benefits

Identifies unnecessary medications
Finds potential drug interactions
Reduces accidental duplication
Can reveal OTC products that deserve caution
Helps ensure doses remain appropriate
Gives you a chance to discuss side effects

Possible downsides

It may reveal that you need additional monitoring
Some medications may require gradual changes rather than immediate stopping
A review can be time-consuming when many specialists are involved

But the goal isn’t to reduce the number of pills at any cost.

The goal is to make every medication earn its place.

What 2026 Patients Should Know

Medication safety is increasingly about the entire treatment picture rather than one prescription in isolation.

Older adults often receive care from multiple clinicians, use pharmacy and mail-order services, and supplement prescriptions with OTC products.

That makes maintaining an accurate medication list more important than ever.

Digital medication records can help, but don’t assume every healthcare system automatically has a complete list.

If you see several clinicians, ask each one to reconcile your medications.

And whenever you buy an OTC product, check the active ingredients rather than relying only on the front of the package.

Frequently Asked Questions

Which medications can increase heart attack or stroke risk?

Several medication categories can carry cardiovascular concerns, including non-aspirin NSAIDs. Certain decongestants and other medications can also affect blood pressure or cardiovascular function in susceptible people. The actual risk depends on the specific medication, dose, duration, medical condition, and other drugs being taken.

Are ibuprofen and naproxen dangerous for older adults?

Not automatically. They can be useful medicines, but non-aspirin NSAIDs carry FDA warnings about increased cardiovascular risk, particularly with higher doses and longer use. Older adults with heart disease, high blood pressure, kidney disease, or other risk factors should ask a healthcare professional before using them regularly.

Should older adults stop taking NSAIDs?

No. Don’t stop a prescribed medication or change a treatment plan based solely on an article. Ask your doctor or pharmacist whether the specific NSAID, dose, and duration are appropriate for you.

Can cold medicine raise blood pressure?

Some decongestants can affect blood pressure and heart rate. The FDA advises people with heart disease or high blood pressure to ask a healthcare professional before using nasal decongestants.

Is aspirin dangerous for seniors?

Aspirin can increase bleeding risk, but it can also be beneficial for certain people with established cardiovascular disease or a previous heart attack or stroke. Whether it is appropriate depends on the individual. Don’t start or stop daily aspirin without professional guidance.

Why do medications become more complicated with age?

Age-related changes can affect how medicines are absorbed, processed, and eliminated. Older adults are also more likely to have multiple health conditions and take multiple medications, increasing the possibility of interactions.

Can two safe medications become risky when taken together?

Yes. Drug-drug interactions can change how medications work or increase unwanted effects. This is one reason healthcare professionals need a complete list of everything you take, including OTC medicines and supplements.

Should I ask a pharmacist about my medications?

Absolutely. Pharmacists are trained to identify potential medication interactions, duplicate ingredients, dosing concerns, and other safety issues. They can also help you understand OTC labels.

What should I do if I experience chest pain after taking a medication?

Chest pain can have many causes, but new or severe chest pain should be treated as a potential emergency. Seek immediate medical attention rather than waiting to determine whether the medication is responsible.

What’s the safest way to reduce medication risks after 60?

Keep an updated medication list, tell every healthcare professional about all prescription and OTC products you use, avoid adding medicines without checking for interactions, and have your medication regimen periodically reviewed. The FDA specifically recommends these types of medication-safety practices for older adults.

Your Medication Safety Checklist

Do

☐ Keep a current medication list
☐ Include prescription and OTC medicines
☐ Include vitamins and supplements
☐ Check active ingredients on OTC products
☐ Ask about cardiovascular side effects
☐ Ask whether your kidney function affects dosing
☐ Review medications after major health changes
☐ Tell every healthcare professional what you’re taking
☐ Ask a pharmacist about possible interactions

Don’t

☐ Stop prescription medication suddenly
☐ Assume OTC means risk-free
☐ Double up on products containing the same ingredient
☐ Start daily aspirin without professional advice
☐ Regularly use NSAIDs without discussing the risks if you have cardiovascular disease
☐ Ignore new chest pain or stroke-like symptoms
☐ Assume supplements cannot interact with prescriptions

There is no universal list of five medications that every older adult should avoid.

That’s not how medication safety works.

The more useful message is that certain medication categories deserve particular attention when cardiovascular risk is already elevated.

Non-aspirin NSAIDs have an FDA warning for increased risk of heart attack and stroke. Some decongestants can affect blood pressure and cardiovascular function. Certain stimulants and other specialized medications may also require careful cardiovascular assessment, while some antipsychotic drugs carry serious warnings for elderly patients with dementia.

At the same time, many of these medications can be appropriate and beneficial when prescribed for the right person.

So don’t panic over a pill bottle.

Review it.

Ask why you’re taking it, whether the dose is still appropriate, whether it interacts with anything else you use, and whether your health has changed since it was prescribed.

For older adults, the safest medication isn’t necessarily the one with the fewest side effects on paper.

It’s the medication—and overall treatment plan—that makes sense for your specific health situation.

Don’t stop a medication because of a scary headline. Instead, make medication review part of your routine, especially if you have heart disease, high blood pressure, kidney problems, a previous stroke, or take several medicines.

Medical disclaimer: This article is for general education and is not a substitute for individualized medical advice. Medication risks vary substantially by drug, dose, duration, medical history, and drug combinations. Never stop or change a prescribed medication without first speaking with your healthcare professional.