Little is known about secondary prevention of cardiovascular diseases, using cardio-protective drugs, in the community-level, especially in low- and middle-income countries. We aimed to assess main drug use and its predictors in Northeast of Iran.This is a cross-sectional analysis on the Golestan Cohort Study data (2004-2008) with 50 045 participants. We assessed drug use in those with a history of ischemic heart disease (IHD) or stroke, recorded by face-to-face interviews. We explored drug use predictors (i.e., age, gender, wealth, education, residency, smoking, body mass index, physical activity, hypertension, and diabetes) through multivariable logistic regression.A total of 3371 (6.7%) participants (56.7 ± 9.0 years, 58.1% female) reported a history of IHD, stroke or both. Median duration since diagnosis was 3.14 years (IQR: 1.25-6.30). Rates of using anti-platelets, statins, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and beta-blockers were 28.8% (95% CI: 27.3-30.3), 5.4 (4.7-6.2), 15.7 (14.5-17.0), and 40.6 (38.9-42.3), respectively. About 43% (41 - 45) of patients did not use any protective drugs. Use of ≥ three drugs was only 7.3% (6.6-8.2). Indicators of ≥1 drug use were: older age (OR for ≥60 vs. <50: 1.37), high wealth score (fifth vs first quintile: 1.60), literacy (1.56), city dwelling (1.32), body mass index (<18.5 and ≥30 vs. 25-29: 0.55 and 1.25, respectively), physical activity (third vs. first tertile: 0.64), hypertension (3.47), and diabetes (1.29); (all P < 0.05).Drug use after IHD or stroke is low in Northeast of Iran. Comprehensive efforts to promote secondary prevention are urgently needed.