More than one third of Kiwis who have suffered a heart attack are not taking medication to prevent heart disease and even less are doing recommended therapies, cardiologist and professor Ralph Stewart says.

In an article penned by Stewart in the New Zealand Medical Journal he posed the question "Is general practice identification of prior cardiovascular disease at the time of cardiovascular disease risk assessment accurate and does it matter?"

The report found that despite strong evidence and clear guidelines, a third of New Zealanders were not taking drugs that reduced levels of cholesterol in the blood one year after an acute heart attack.

"Some people think taking medication makes them less healthy and want to reduce the number of tablets they take, even though for many an increase in treatment could lower risk further.

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"Over 20 years adhering to optimal preventive medication may increase the chance of being alive without a major heart attack or disabling stroke from less than one in three to more than 70 per cent."

In the last 10 years thousands of New Zealanders have had a cardiovascular risk assessment completed using simple risk algorithms such as "predict".

"When completing this risk score, the most important 'box' is 'prior cardiovascular disease' (CVD).

"This identifies patients who usually have a much higher risk compared to people with risk factors alone, and who almost always have a clear indication for preventive medication."

Stewart said 40 per cent of patients that had been hospitalised previously for a major cardiovascular event had 'no' indicated for prior cardiovascular disease in the GP's predict risk algorithm.

Even fewer Kiwis were adhering to recommend therapies, he said.

Side effects from the drugs, real or not, were a common reason for a patient to stop taking medication, the journal said.

Negative expectations of treatment or prognosis from the prescribed heart medication was a major contributor to people not taking their pills.

Better execution of prevention measures following a heart attack would "substantially decrease" cardiovascular morbidity and mortality.