Despite big increases in heart patients on medication, most still have high blood pressure and nearly half have high cholesterol.
Researchers interviewed more than 8,500 patients in eight countries. Patients were on average about 60 years old, and had a history of heart problems.
The experts found that more young patients are smoking, and more patients are fatter and diabetic compared with similar groups from 12 years ago.
The study was published Friday in the medical journal, Lancet.
"In terms of the lifestyles of patients with coronary disease, everything is moving in the wrong direction," said Dr. David Wood, one of the paper's authors and a professor of cardiovascular medicine at Imperial College in London.
The study was supported by the European Society of Cardiology and paid for by pharmaceutical companies that make heart drugs.
Researchers also found that the numbers of patients taking drugs to lower their cholesterol was seven times higher in 2006-2007 than in 1995-1996. About 43 percent of patients still had high cholesterol.
And while more people now take medications to lower their blood pressure, Wood said that hadn't made any difference. "The response of physicians is just to give more and more drugs, but what we need is a comprehensive lifestyle program."
Experts said trends were similar in the United States.
"Even if we advise patients to lose weight, they have to walk out the door and do that themselves," said Dr. Alfred Bove, incoming president of the American College of Cardiology.
Bove, who was not linked to the study, said more patients were now being treated for high blood pressure, but millions were unaware they even had a problem.
In the last decade, deaths due to heart disease have dropped by about 30 percent in the United States and 45 percent in Britain. But the rates are leveling off, and experts worry the surge in obesity and diabetes will reverse previous successes.
Even with advances such as medications, heart stents and angioplasties, Dr. Daniel Jones, a past president of the American Heart Association, said that fighting heart disease "is like swimming upstream."
Jones, who was not connected to the Lancet study, warned that the widespread use of heart drugs has masked the effects of the obesity epidemic and that it would be even worse without them.
"We know that giving medications will reduce patients' risk, but we shouldn't put all our eggs in that one basket," he said. "We need to work harder on preventing problems at their root."