Precision cardiovascular medicine: a time for global health leadership

Cardiovascular health for all demands national action plans that integrate precision approaches based on globally representative research—enabled by leadership committed to equitable access and context-relevant implementation.

DOI: https://doi.org/10.25453/plabs.30354343

Published on October 14th, 2025

Cardiovascular disease (CVD) is a story of both progress and missed opportunities. While recent decades have seen decreasing CVD mortality rates, progress has been unequal across world regions and has recently stagnated in some countries. Meanwhile CVD remains the leading cause of death worldwide, and hundreds of millions of people with hypertension, the leading risk factor, remain undiagnosed (1,2). The insightful discussions of precision cardiovascular medicine in the Frontiers in Science lead article by Aikawa and colleagues (3), and implementation perspectives provided by Medina-Inojosa and colleagues (4), similarly highlight both significant opportunities for progress, but also the risk of leaving that potential unfulfilled.

The potential is clear for all to see. Precision technologies offer new avenues for treatment, changing the lives of patients through therapies that are better adapted to their specific circumstances and pathology. For the World Heart Federation (WHF), an organization whose vision is “cardiovascular health for everyone”, this promise resonates deeply.

However, as we regularly see in issues of health, the effectiveness of new technologies is not in itself enough. These technologies must be both developed and implemented in an equitable way. WHF’s vision of “cardiovascular health for all” is necessarily underpinned by pillars of technological innovation and equitable implementation. The need for innovation to be coupled with concerted efforts to ensure fair access is reflected in an insightful framework for implementing precision cardiovascular medicine provided by Medina-Inojosa and colleagues (4), which holds a clear message; equity-first policies must be central to all development and implementation of precision tools, otherwise they risk exacerbating inequalities rather than reducing them. To benefit all populations, precision tools need to reflect all populations in their inputs, need to be applied with a preventive mindset, and need to be accessible in low-resource settings (4).

We therefore have before us the scientific knowledge and policy levers guiding the most appropriate path forward. What is now needed is global and local leadership to ensure that this is the path taken. An equitable, population-based vision is not one that naturally guides the development, commercialization, and implementation of new technologies. Such a vision requires leadership, from governments and civil society. This is vital to ensuring a systems-wide, multistakeholder approach to precision cardiovascular medicine implementation. Only well-informed, impartial, and trusted global health leaders can unite the diverse forces and actors needed to achieve this.

Recently, the spotlight was shone on global cardiovascular health leadership during the 2025 United Nations (UN) General Assembly in New York. Here, member states convened to deliberate on the 4th Political Declaration on Non-Communicable Diseases (NCDs) (5). The Declaration will play an important role in guiding the priorities, financing, and targets which national governments set when planning their NCD response. Under this spotlight, we see the complexities faced when implementing health innovations, and the need for deliberate efforts to drive forward the policy approaches mentioned above.

To highlight examples, we can consider some of the key recommendations put forward by the WHF in its response to the draft Declaration. The specific target to increase by 150 million the number of people with hypertension under control by 2030 falls well short of the 500 million advocated by the WHF. This hesitation around more ambitious hypertension control targets is paralleled by the language removed from the draft Declaration relating to access to statin-based therapies. This reveals an important challenge; access to even basic diagnostics and therapies in many parts of the world is severely limited. In the Frontiers in Science article hub, the editorial by Fuster and colleagues makes a clear case for why such challenges should not deter us from the aim of widespread implementation of precision medicine (6). Population-based approaches to these risk factors should provide an essential framework for reduction within which precision cardiovascular medicine can ultimately be applied. The draft Declaration on NCDs recognizes and provides guidance to support this, including strategies to promote medicine affordability and increase healthcare financing at national level that can be applied to all technologies (5).

The draft Declaration mentions the need for more equitable approaches to technological innovation, including populations previously underrepresented in research. This is especially true when considering precision tools, whose potential to ensure targeted care for all is reliant on globally representative data being used in their development and validation. The draft Declaration also highlights the need to increase the number and capacity of healthcare workers. By 2030, a shortfall of 11 million health workers is predicted (7). Medina-Inojosa and colleagues note the potential of precision tools to support health workers through decision support and remote analysis, but this is only possible if tools are accompanied by co-developed and contextualized programs to provide health workers with the skills and infrastructure required (4).

Finally, a major element of debate during drafting were the recommendations related to the social, commercial, and environmental determinants of NCDs in the Declaration (8). As Aikawa and colleagues eloquently point out, it would be a grave mistake to hold precision cardiovascular medicine as a silver bullet whilst ignoring the proven steps we can take to remove the root causes of CVD (3). Issues such as obesity, air pollution, and taxation of unhealthy commodities such as sugar-sweetened beverages must remain cornerstones of our efforts.

Looking beyond the UN General Assembly, the WHF now turns its attention to global implementation. Driving this is an aspirational goal; all countries should have a national cardiovascular health action plan. Precision cardiovascular medicine should be reflected across such plans. The ability of countries to do so will be dependent on several factors, including continued development of precision tools based on globally representative research and design, equitable access, and well-conceived national implementation programs based on context-relevant technical guidance. Naturally, the integration of precision tools into such plans will look different in different settings. But the opportunity for all countries to include them in the most appropriate way is one that we must ensure, and one that is vital to our goal of advancing towards cardiovascular health for everyone.

Copyright statement 

Copyright: © 2025 [author(s)]. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in Frontiers Policy Labs is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.     

Generative AI statement 

The author declares that no generative AI was used in the creation of this article.

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