OBJECTIVES: To report the utilization of guideline recommended statins, angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), and beta-blockers (BB) for secondary prevention of coronary heart disease (CHD) in community-dwelling Medicare beneficiaries ≥65 years. METHODS: Data from the 2004-2006 Medicare Current Beneficiary Survey were utilized to conduct a retrospective, cross-sectional study.  Community-dwelling Medicare beneficiaries ≥65 years of age indicating a past history of CHD or myocardial infarction were selected.  All commercially available statins, ACEIs/ARBs, and BBs in the US, including brand, generic and combination products, were included.  Medication possession ratio (MPR) was the proxy used for adherence, defined as ≥80% MPR.  Descriptive statistics were used with sampling weights applied for all analyses. RESULTS: The 2004, 2005 and 2006 sample sizes were 2,338,741, 2,186,251, and 2,159,661, respectively.  At least one prescription medication for statins was reported in 62.2%, 62.4% and 64.0% of beneficiaries in 2004, 2005 and 2006.  Adherence in beneficiaries having at least one prescription for a statin was 44.6% in 2004, 47.4% in 2005, and 54.5% in 2006.  In 2004, 2005, and 2006, 59.1%, 55.3%, and 56.5% of beneficiaries reported at least one prescription for an ACEI/ARB with 45.1%, 40.8%, and 57.2% of beneficiaries with at least one prescription for an ACEI/ARB achieving ≥80% adherence.  At least one BB prescription was reported for 57.3%, 58.4%, and 61.5% of beneficiaries in 2004, 2005, and 2006, respectively.  Adherence to BBs for those beneficiaries reporting at least one BB prescription was 35.1%, 44.5%, and 53.6% in 2004, 2005, and 2006, respectively.  The percentage of beneficiaries reporting at least one prescription for all three medications in 2004, 2005, and 2006 were 27.5%, 26.3% and 29.4%. CONCLUSIONS: Utilization of guideline recommended pharmacotherapies for secondary prevention of cardiovascular morbidity and mortality in this US Medicare patient population have improved over time but remain suboptimal.