According to a study published Tuesday, Aug. 22, only 40.3% of people who have suffered a heart attack or stroke reported taking aspirin to help prevent a second one. The study, published in the medical journal JAMA, looked at data from 51 different low-, middle-, and high-income countries.

The study found aspirin use to prevent a second heart attack or stroke ranged from 16.6% in low-income countries like Afghanistan, Benin and Ethiopia to 65% in high-income countries like Czechia, the United Kingdom and the United States.

The World Health Organization (WHO) has a goal of getting at least 50% of eligible people on some kind of drug therapy and counseling to prevent heart attacks and strokes.

“We had hoped that the rates of aspirin use for secondary prevention would be much higher. Particularly I think, overall, globally, there has been an emphasis on improving cardiovascular health, and one of the efforts is to improve use of some of these evidence-based medications,” Dr. Sang Gune Yoo, an author of the study, told CBS news. “What our study is highlighting is that despite efforts being put in to improve cardiovascular health globally, aspirin continues to be underused in secondary preventions.” 

According to the WHO, cardiovascular diseases are the leading cause of death worldwide. Over 80% of the 18 million cardiovascular deaths each year are due to heart attacks and strokes.

“Given that it continues to be the number one cause of mortality, it’s very important that health systems and countries strategize ways to improve uptake of aspirin use as well as other cardiovascular medicines,” Yoo said.

According to a study set to be presented at the upcoming European Society of Cardiology Congress, heart attack and stroke survivors who didn’t consistently take aspirin had a greater risk of having a subsequent incident than those who took aspirin on a regular basis.

However, the US Preventive Services Task Force recommends against adults 60 and older starting on low-dose aspirin for the primary prevention of cardiovascular disease. For people ages 40 to 59 who have a 10% or greater risk of cardiovascular disease over 10 years, the task force leaves the decision up to doctors and patients.