Of an estimated 55 million deaths in the world in 2017, the researchers said around 17·7 million were due to cardiovascular disease a group of conditions that includes heart failure, angina, heart attack and stroke.
Around 70% of all cardiovascular cases and deaths are due to modifiable risks such as high blood pressure, high cholesterol, diet, smoking and other lifestyle factors.
In high-income countries common treatment with cholesterol-lowering statins and blood-pressure medicines have helped bring rates of heart disease down dramatically in the past few decades.
Dagenais team said their findings suggest that the higher rates of heart-disease deaths in low-income countries may be mainly due to a lower quality of healthcare.
The research found first hospitalisation rates and heart disease medication use were both substantially lower in poorer and middle-income countries than in wealthy ones.
Countries analysed included Argentina, Bangladesh, Brazil, Canada, Chile, China, Colombia, India, Iran, Malaysia, Pakistan, Palestine, Philippines, Poland, Saudi Arabia, South Africa, Sweden, Tanzania, Turkey, United Arab Emirates and Zimbabwe.
The research was part of the Prospective Urban and Rural Epidemiologic study, published in the Lancet and presented at the ESC Congress in Paris.