Cardiovascular disease is responsible for more than 40% of all deaths in Europe. Decades of research and investment have achieved impressive declines in overall cardiovascular disease mortality, yet this progress hides a persistent injustice: the benefits of prevention, diagnosis, and treatment have not been shared equally across different strata of populations. Avoidable inequalities in cardiovascular health continue to claim lives, undermine health and wellbeing, and limit individuals’ opportunities to lead full, productive lives, exposing deep structural flaws in our health systems and research agendas.

To confront these inequities, The Lancet Regional Health—Europe has launched a Series on Inequalities and Disparities in Cardiovascular Health, as part of ongoing work towards a Commission. This Series brings together leading experts to examine the evidence on four groups that face persistent disparities in cardiovascular health: women, ethnic and racial minorities, older people, and people with mental health conditions. Each paper in this Series explores the unique and overlapping barriers these groups face—from bias and underrepresentation in research, to reduced access to health care and systemic failures in its delivery, to the compounding effects of social and economic disadvantage. Collectively, the Series provides a set of recommendations to address these disparities.

The inequalities are striking. Women have long been underdiagnosed, undertreated, and underrepresented in cardiovascular disease research. Although women generally develop ischaemic heart disease later than men, their mortality rates are paradoxically higher, even in high-income countries. For example, in 2019, women in Germany and Austria were about 25–30% more likely to die from ischaemic heart disease than men of the same age. Studies too often assume that the typical cardiovascular patient is male, and clinical guidelines and risk scores reflect this bias. Delays in diagnosis and treatment, particularly for acute myocardial infarction, are not merely common—they are lethal. The burden is compounded by psychosocial stressors, caregiving responsibilities, and socioeconomic disadvantage, all of which disproportionately affect women.