While early death from cardiovascular disease (CVD) has decreased in rich countries, it is still high in low-income and middle-income countries. Why? One reason is because in rich countries, there is more access to medicines that lower risk from CVD (for example in people who live with diabetes). A new study found that medicines to prevent CVD are usually unavailable or too expensive for people in low-income countries. This can increase risk of stroke, heart attack, and death. The World Health Organization set a target of 80% availability of affordable essential medicines for prevention of CVD, where at least half of the people who need these medicines get them. This study suggests that the cost of medicine will continue to be a barrier in reducing CVD. Medicine access may also be a challenge for high-risk communities in the United States.