Echoes of Inequity: A Critical Examination of the Past, Present, and Future of Cardiac Health Equity

Abstract

Purpose of review: This review explores the historical, structural, and biological foundations of cardiovascular (CV) health inequities in the U.S. It examines how disparities by ancestry, sex, geography, income, immigration status, and race have emerged, persisted, and, in some cases, worsened while evaluating strategies for advancing equity. Recent findings: Despite progress in prevention and treatment, key disparities remain entrenched. Structural inequities, socioeconomic exclusion, and underrepresentation in research continue to shape outcomes. Social adversity is increasingly understood to exert biological effects through mechanisms such as chronic stress, cardio-kidney-metabolic dysfunction, and epigenetic aging. Novel tools, including place-based deprivation indices, precision risk prediction models, and community-driven interventions offer actionable pathways forward but remain underutilized or unevenly implemented. Summary: Cardiac health equity requires more than clinical innovation; it demands structural reform, inclusive science, and equity-centered implementation. Future solutions must embed social context into care, research, and policy to drive durable, population-level impact.