Opinion: It’s time to unlock funding and innovation for cardiovascular care

Atherosclerosis and other cardiometabolic diseases are the leading causes of death worldwide, yet millions in lower- and middle-income countries still lack essential diagnostics and lifesaving medicines. The fact that so many are overlooked when effective interventions are readily available elsewhere is a shocking injustice. Throughout my career as a physician working in public health care in South Africa, I have seen firsthand the difference access to quality health care can make to the lives of patients and their families. Given the staggering inequalities in cardiovascular care across the globe, it is essential to unlock financing and innovation to address cardiometabolic diseases and break social barriers to accessing care. A global health emergency Cardiometabolic diseases — heart and metabolic health conditions — result in around 17.9 million deaths each year. Atherosclerosis, meaning clogged or hardened arteries, is the leading cause of cardiovascular diseases. Everyday risk factors — such as diet, physical inactivity, tobacco and alcohol consumption, and air pollution — are important drivers of cardiovascular risk. Genetics also play an important part, and in some cases — such as familial hypercholesterolaemia, a genetic condition where cholesterol levels are very high from birth — a dominant role. Unfortunately, the prevalence and intensity of the risk factors outlined above is increasing in much of our planet, and particularly so in low- and middle-income countries, where the threat of cardiometabolic disease continues to rapidly grow. Too often, risk factors are only being addressed, and then imperfectly, in high-income countries. But, in truth, low- and middle-income countries bear an increasingly disproportionate burden. Lower- and middle-income countries contribute to 80% of all global deaths from cardiovascular disease. Despite the significant health burden faced by people in these countries, they are often unable to experience the full benefits of recent scientific breakthroughs. Limited access to cutting-edge research means they miss out on participation in clinical trials, innovative treatments, and advanced diagnostic tools. The burden of cardiovascular diseases extends even further than this. For the individuals, families, and carers affected, diagnosis exacerbates poverty, as many are forced to either go without even basic medication or incur significant out-of-pocket costs due to limited health coverage. The time to act is now We are at a turning point in our fight against cardiovascular diseases. Not only is the threat continuing to grow, but we face new and unique challenges. Lower- and middle-income countries must not become forgotten markets. Greater protection is essential, achievable through improved access to essential diagnostics and treatments, enhancing education on cardiovascular risk factors, highlighting the value of treatment, and upskilling clinicians to deliver high-quality care, regardless of location. The growing anti-science sentiment, in conjunction with skepticism toward the anti-cholesterol medication group of statins, risks undermining trust in proven interventions. Because modern medicine offers risk reduction rather than a silver bullet cure to cardiovascular diseases, there is a real risk that some clients turn to alternative medicine practitioners promising a cure through “natural” ingredients and “healing forces.” Those disillusioned by the long lists of medications often needed in cardiovascular disease prevention and the fact that modern medicine does not promise a cure, just substantiated risk reduction, may succumb to the promises of a cure made by alternative medicine practitioners. It is no longer enough to innovate — we must break down the barriers between patients and the interventions that could save their lives. Unlocking funding and innovation As we look ahead to the United Nations’ fourth high-level meeting on the prevention and control of noncommunicable diseases, or NCDs, in September 2025, we must address the funding gap for cardiovascular disease. Tackling this crisis will require innovative financing solutions, including blended finance and domestic resource mobilization, to ensure sustainable access to lifesaving interventions. Recent innovations in cardiometabolic health, including advanced diagnostics, affordable combination therapies or polypills, and digital solutions, can significantly improve outcomes in lower- and middle-income countries. Efforts need to focus on scaling access, integrating solutions into primary care, and advocating for disease-specific funding within the NCD framework to close care gaps. This is a global health emergency, and once more, it is the most vulnerable who are being left behind. As leaders in the global cardiovascular disease community, we have a responsibility to ensure that the latest science and knowledge reaches everybody who needs it. A call to action The need for a united, global front to address inequalities in cardiovascular care has never been more urgent. And this is not just about health; it’s about social, economic, and geographic inequity as well. This is a matter of justice and humanity. Clinicians, health economists, policymakers, NGOs — anyone with a stake in global health must recognize the wider threat posed by cardiovascular disease. With our triennial International Symposium on Atherosclerosis approaching, and as I prepare to step into the role of president of the International Atherosclerosis Society, I invite you to join us on this mission. I am calling on the global network of health care professionals, researchers, and patient organizations to join together in advocating with a united voice for the funding solutions needed to ensure that all people — no matter where they live — have access to the resources, care, and lifesaving treatments they need.