Statins - cholesterol-lowering drugs - should be prescribed for more people in the UK to be effective in reducing heart disease, researchers have said.
The researchers looked at who should receive medication
A team from the University of Manchester studied a group of 1,600 middle-aged men over a decade.
Writing for the journal Heart, they said UK policy would have prevented only 20 of more than 200 heart attacks and strokes which occurred.
But the government said statin prescribing was increasing annually.
The researchers looked at 1,653 men aged 49 to 65 from the mid-1980s to the mid-1990s, and recorded how many of them had a heart attack or stroke.
They then calculated how many people would need to have been given statins to prevent all of these cardiovascular events, and how the application of current UK, European and US guidelines would have affected the figures.
They also looked at the potential number of serious disease episodes which could have been prevented in the population as a whole, through statin treatment.
Over the 10 years there were 212 heart attacks or stroke among the men.
The UK government's National Service Framework recommendations target those at highest risk, and would require just 14% of the group to be treated.
But this only cuts the rate of heart attack or stroke in the overall population by 9%.
European guidelines resulted in 46% of the group being treated, and a reduction of 19%. For US guidelines the figures were 60% treated and around 22% fewer heart attacks and strokes.
The researchers, led by Professor Paul Durrington, said statin treatment will make little difference to the overall rate of cardiovascular disease unless it is targeted at all those at average risk - most middle-aged men and most older women.
They added: "Whether cholesterol lowering on such a scale should be attempted with drugs raises philosophical, psychological, and economic considerations."
Professor Durrington's team also said more effective national policies on nutrition to reduce reliance on statins should also be considered.
They highlighted a "lack of resolve in tackling Britain's unhealthy diet," which has led to one in three of Europe's obese children being British.
Roger Boyle, the government's National Director for Coronary Heart Disease, said: "Statin prescribing has been rising by 30% year-on-year in the NHS since publication of the Coronary Heart Disease NSF in 2000, and we estimate that this is responsible for saving up to 9,000 lives a year.
"Statin prescribing is one key weapon in the NHS's armoury when in comes to managing cardiovascular risk.
"However, this needs to go hand in hand with the massive programme of work that is under way to change unhealthy lifestyles and tackle the causes of heart disease, which remains a national priority."
Professor Peter Weissberg, medical director of the British Heart Foundation, said: "This study suggests that if we are going to have a real impact on heart attacks and strokes, many more people should receive statin treatment than current guidelines suggest.
"In fact, guidelines are constantly evolving and the 'goal posts' are constantly moving towards treating more and more people at lower and lower risk of a heart attack or stroke."
He added: "There is a real public health dilemma emerging.
"This suggests that we must either treat many more people who are conventionally considered to be at relatively low risk of a heart attack, or we must be much more aggressive in our attempts to prevent the disease from occurring in the first place."