What’s New and Important This work calls for the establishment of a global, co-produced research agenda focused on equity and intersectionality in cardiovascular disease care with clinicians, researchers, patient partners, and community organizations from around the world. This call to action highlights the need for culturally safe, gender-responsive, and socially informed approaches to cardiovascular disease research and practice at the global level. Integrating research priority areas into clinical care can support more inclusive guideline development, improve patient engagement, and reduce inequities experienced by women, racialized groups, Indigenous peoples, gender-diverse individuals, and other marginalized communities. Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, yet access to high-quality prevention, diagnosis, and treatment is not equitably distributed across populations.1 Equity-deserving groups, including women, racialized populations, Indigenous peoples, gender-diverse individuals, and people living in low-middle-income countries, experience significant disparities in cardiovascular care.2 Structural racism, sexism, and systemic biases within healthcare systems contribute to inequities in CVD prevention (eg, underrepresentation in screening), diagnosis (eg, delayed recognition of atypical symptom presentation), and treatment (eg, disparities in access to evidence-based therapies).2–5 These inequities are particularly pronounced in chronic CVDs that require long-term management and ongoing use of the healthcare system.5 Inequities in Cardiovascular Care The burden of CVD is unevenly distributed across equity-deserving groups. CVD research, for example, has been predominantly focused on men, as women have been underrepresented in clinical trials and less likely to receive guideline-directed therapy.6 This has led to a lack of evidence in sex- and gender-specific outcomes.6 As a result, there has been great emphasis on CVD management among men, while women’s cardiovascular health remains unaddressed due to a lack of context-specific care.6 Racialized populations experience higher rates of CVD hospitalization and worse outcomes, often linked to systemic barriers such as limited access to cardiac rehabilitation, socioeconomic disadvantage, and structural discrimination within the healthcare system.4,7,8 For example, people of South Asian and African descent have a higher prevalence of CVD than Caucasian people,9–11 with both groups also experiencing a greater burden of premature CVD.12–14 Additionally, South Asian and Black people have a higher prevalence of diabetes and obesity compared to the general population, which are major risk factors for CVD.15,16 Indigenous peoples face disproportionately higher rates of CVD-related morbidity and mortality, reflecting a complex interplay of colonization, intergenerational trauma, geographic isolation, and gaps in culturally safe care.17,18 Gender-diverse and 2SLGBTQ+ individuals also encounter barriers to timely diagnosis, respectful treatment, and continuity of care due to stigma, discrimination, and a lack of provider knowledge about gender-affirming therapies in the context of CVD management.19,20 Intersectionality and Cardiovascular Disease Despite growing recognition of inequities in CVD care, most research has examined social determinants of health in isolation. This approach overlooks the intersectionality of identities and the compounding effect of multiple systems of oppression on health outcomes.21 For example, the experiences of a racialized woman living with CVD cannot be fully understood by examining sex or race alone.22 Instead, the intersection of these identities generates unique patterns of disadvantage that affect their access to prevention, diagnosis, and management of CVD.21–23 Recent research has highlighted the need for intersectionality-informed approaches in cardiovascular research and care delivery.21–23 Structural inequities must be understood as connected and interlocked, rather than additive, determinants of CVD outcomes.21–23 However, intersectionality-based analyses remain scarce in the CVD literature, which has led to critical gaps in how we understand and deliver equitable CVD care. Gaps in Equity-Oriented Cardiovascular Health Research Despite the disproportionate burden of CVD among equity-deserving groups, there is a lack of research that adequately addresses their needs. Major evidence gaps exist across the spectrum in the delivery of equitable CVD care, including prevention, diagnosis, treatment, and long-term management.21,22 These gaps have limited the development of culturally safe, gender-responsive, and equity-oriented healthcare interventions with respect to CVD care. Furthermore, policy and clinical guidelines are often generalized and derived from evidence generated in predominantly high-income contexts, reducing their applicability to diverse groups with varying socioeconomic statuses.24 Our team has recently co-produced an intersectionality-informed research agenda in this area with clinicians, community health organizations, health system, and academic partners in the Western world. However, there is currently an urgent need to generate a global research agenda to guide equitable CVD research and practice, globally, especially including partners from Global South. What is Needed A global effort is needed to cocreate a universal research agenda focused on equity and intersectionality in CVD care. This effort should not only identify priority areas for research but also build a sustainable network of clinicians, researchers, patient partners, and community organizations committed to advancing equity-based cardiovascular care across the globe. However, because research priorities cannot be shaped through informal or ad-hoc conversations, a structured and transparent approach is needed so that all stakeholder perspectives are valued equally and integrated into the resulting priorities. Call to Action This editorial calls for a global commitment to bringing together the many stakeholders who have the expertise and lived experience of advancing equitable cardiovascular care. Progress cannot be made through scattered or informal discussions; rather, it requires structured, coordinated conversations across clinician, researcher, patient, caregiver, and community groups. These stakeholders must convene through an organized and equity-centered process to identify shared priorities that reflect the realities of those most affected by cardiovascular inequities. Establishing these co-produced priorities is an essential next step toward building an actionable agenda that can guide equitable cardiovascular research, practice, and policy across the world. James Lind Alliance Approach for Research Priority Setting A structured and transparent process is essential to set research priorities; therefore, the James Lind Alliance (JLA) approach provides an appropriate and rigorous framework to guide this work. At the core of the JLA approach is the creation of priority-setting partnerships: collaborations between patient and community partners, CVD clinicians, and academic researchers who work together as equal partners to identify gaps in evidence and define shared research priorities.25 The process emphasizes equal voice and shared decision-making among stakeholders.25 It ensures that academic or institutional power imbalances do not overshadow community and patient perspectives.25 Through several meetings, each stakeholder group presents their research priorities and ideas, followed by a collective process of consolidating and ranking the most important priorities across groups. The end result is a co-produced list of priority research questions that reflect real-world needs, guiding researchers toward projects that have the greatest potential for patient and system impact.25 These are the 5 stages used in the JLA approach to set priorities: (1) initiation (setting up a priority-setting partnerships), (2) consultations (gathering uncertainties), (3) collation (data processing and verifying uncertainties), (4) interim priority setting, and (5) final priority setting.25 Benefits of Setting Research Priorities A major strength of this type of research priority-setting project lies in its structured and iterative approach to engagement using the JLA approach.25 Conducting several rounds of discussions rather than a single event fosters reflection, allowing experts to clarify priorities and creating genuine co-ownership of the research agenda. Having a team that is composed of multidisciplinary perspectives, including clinicians, academic researchers, patient partners, and representatives from equity-deserving communities, enhances the credibility and comprehensiveness of findings. Regular cross-group communication ensures that diverse voices are integrated rather than siloed. The process also models principles of equitable partnership, aligning with frameworks for coproduction in health equity research.26 However, this type of approach and project represents an early-stage agenda-setting process. It provides a foundation rather than conclusive empirical outcomes. Implications of Priority-Setting Exercises The priority-setting exercise for equitable cardiovascular care may have implications for research and practice. For example, the identified thematic priority areas can guide future research funding and collaborative initiatives in equitable CVD care that align with national and global calls for intersectional approaches to cardiovascular research.21,22,27 Furthermore, establishing a shared research network through this research agenda can enable continued coproduction and ensure studies that come from the research priorities are embedded within the community and clinical practice. At the practice level, the JLA framework provides a template for engaging equity-deserving populations in health equity research. Therefore, this work can empower people with lived experience to influence research and clinical protocols, transforming CVD practice. By integrating patient and caregiver expertise into guideline development and clinical training, future practice can move beyond a biomedical model toward a socially responsive and culturally safe system of care. Conclusion Achieving equity in cardiovascular care now requires coordinated and intentional action. This paper urges clinicians, researchers, patients, and community partners from around the world to come together through a structured and intersectionality-informed dialogue using the JLA approach to identify shared priorities for equitable CVD care. Establishing these cocreated priorities will guide future research, strengthen long-term partnerships, and support equitable CVD care for historically marginalized communities.
Allana et al. (Fri,) studied this question.