Introducing <i>The Lancet Regional Health-Europe</i> commission on inequalities and disparities in cardiovascular health

The Lancet Regional Health-Europe commission on inequities and disparities in cardiovascular health is a key initiative addressing critical disparities in cardiovascular health across different demographics.1 Chaired by Professor Raffaele Bugiardini from the University of Bologna, with Co-Chairs Professor Chris P. Gale from the University of Leeds and Dr Martha Gulati from Cedars-Sinai Medical Center, this Commission is a concerted effort to tackle one of the most pressing public health challenges of our time. The Commission’s research is organized into four working groups focusing on women, the elderly, ethnicity/race, and stress/mental illness. Each group is led by a distinguished coordinator: Professor Angela H.E.M. Maas (Netherlands) for women, Professor Nick Townsend (UK) for the elderly, Professor Sonia S. Anand (Canada) for ethnicity/race, and Professor Viola Vaccarino (USA) for stress/mental illness. The secretariat is hosted by the Laboratory of Epidemiological and Clinical Cardiology at the University of Bologna, with Doctor Edina Cenko and Professor Olivia Manfrini managing administrative tasks, while Professor Lina Badimon oversees advocacy from the Cardiovascular Program at IR-Hospital de la Santa Creu i Sant Pau in Barcelona. This Commission includes 26 researchers from around the globe (Figure 1). They bring a wealth of expertise from various fields, from clinical cardiology to epidemiology, with representatives from institutions like the University of Edinburgh, Erasmus MC, and Semmelweis University. The Lancet Regional Health-Europe commission on inequalities and disparities in cardiovascular health The establishment of this Commission highlights the urgent need to address disparities in cardiovascular health, which persist despite overall declines in cardiovascular mortality. This initiative aims to uncover and address the reasons behind these disparities and develop policies to bridge gaps in healthcare access and outcomes.1 Research has increasingly focused on sex-based differences in atherosclerotic cardiovascular disease. Men and women experience atherosclerosis differently, with variations in the timing of onset, symptom presentation, and outcomes.2,3 Women often face worse outcomes following acute ischaemia due to differing pathophysiology and risk factors.3,4 This work aims to evaluate these differences and underscore the need for sex-specific approaches in diagnosis and treatment to improve outcomes for women, addressing socio-economic disparities that impact their cardiovascular health.1 The Commission will explore inequalities in cardiovascular screening, diagnosis, and treatment among various ethnic and racial groups, with special attention to Western and Eastern Europe and North America.5–7 The focus will include the intersection of ethnicity, race, and social disadvantages, emphasizing the need for targeted solutions to enhance health equity and calling for further research in this area. Mental disorders significantly contribute to cardiovascular disease, with individuals facing psychological adversities often developing cardiovascular issues earlier and receiving suboptimal care.8–10 This report will summarize existing evidence, identify gaps, and propose strategies to improve cardiovascular outcomes for those with mental illness. The aim is to address barriers to cardiovascular health for people with mental disorders and foster health equity in this under-explored area. Age is a significant risk factor for cardiovascular disease, with older adults experiencing a higher prevalence and different impact of cardiovascular conditions.11 The Commission will explore issues related to cardiovascular disease in the elderly, including prevention and treatment strategies that preserve functional abilities and quality of life. This focus is timely, as the United Nations has designated 2021–2030 as the Decade of Healthy Ageing, emphasizing the need for comprehensive care to manage chronic conditions and maintain independence. In summary, the Commission aims to map the landscape of cardiovascular health disparities across various demographics, including gender, age, ethnicity/race, socio-economic status, and geography. By generating evidence-based insights and developing recommendations for policy, practice, and research, the Commission seeks to advocate for equity in cardiovascular health and influence policymakers, healthcare providers, and the public. The COVID-19 pandemic has intensified existing health disparities, underscoring the critical need for dedicated efforts to achieve cardiovascular health equity. R.B. reports participation on the data safety monitoring board of Aptabio Therapeutics unrelated to this work. C.P.G. reports funding from Horizon 2020, grants or contracts from Alan Turing Institute, British Heart Foundation, National Institute for Health Research, Abbott Diabetes, Bristol Myers Squibb, and European Society of Cardiology, consulting fees from AI Nexus, AstraZeneca, Amgen, Bayer, Bristol Myers Squibb, Boehrinher-Ingleheim, CardioMatics, Chiesi, Daiichi Sankyo, GPRI Research B.V., Menarini, Novartis, iRhythm, Organon, and The Phoenix Group; fees from AstraZeneca, Boston Scientific, Menarini, Novartis, Raisio Group, Wondr Medical, and Zydus; participation on the data safety monitoring board or advisory board of DANBLCOK trial and TARGET CTCA trial; fiduciary role as Deputy Editor: EHJ Quality of Care and Clinical Outcomes, NICE Indicator Advisory Committee, and Chair ESC Quality Indicator Committee: stock or stock options of CardioMatics; and receipt of other services from Kosmos device, all unrelated to this work. M.G. reports unpaid leadership or fiduciary role as President of The American Society for Preventive Cardiology, unrelated to this work.

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