The study also found that people in low income countries, although living with fewer risk factors for heart disease, have a higher incidence of serious cardiovascular disease including death.
The study followed 155,000 people from 628 urban and rural communities in 17 countries over four continents for nearly four years.
The international research team found risk factors for cardiovascular disease was lowest in low income countries, intermediate in middle income countries and highest in high income countries.
However, the incidence of serious cardiovascular disease such as heart attacks, strokes, heart failure and deaths followed the opposite pattern: highest in the low income countries, intermediate in middle income countries and lowest in high income countries.
Hospitalizations for less severe cardiovascular diseases were highest in the high income countries.