A new study published in the Journal of General Internal Medicine has found that high cholesterol levels are often underestimated, leading to tens of thousands of unnecessary heart attacks and strokes.

More than 39,000 deaths, nearly 100,000 nonfatal heart attacks and up to 65,000 strokes could have been prevented if people eligible for statins and other cholesterol-lowering drugs had taken them, the researchers said.

They analyzed cardiovascular risk profiles and cholesterol level data from nearly 5,000 U.S. adults who participated in national health surveys between 2013 and 2020.

Among participants who had never had a heart attack or stroke, 47% were eligible for statins, according to U.S. guidelines. But only 23% had ever received them as prescribed by a doctor, according to the results.

Among patients with a history of heart attack or stroke, only 68% received cholesterol-lowering treatment, despite 100% being eligible.

According to the researchers, there are several reasons for these gaps in care, including “differences in physician training, patient preferences, barriers to accessing care, financial incentives that do not always support best practices, and difficulty implementing clinical guidelines in practice in tense real-world settings.”