The Role of the Pharmacist in Health Disparities in Cardiometabolic Disease

Cardiometabolic diseases are increasingly prevalent and represent a growing public health burden. These largely preventable conditions, which affect the heart, blood vessels, and metabolism, include conditions such as type 2 diabetes, hypertension, dyslipidemia, obesity, chronic kidney disease, and atherosclerotic cardiovascular disease. Common drivers include lifestyle factors such as poor diet, smoking, excessive alcohol consumption, and physical inactivity.

The American Heart Association has named this set of conditions as cardiovascular, kidney, and metabolic (CKM) syndrome. Recent estimates suggest that approximately 90% of adults in the United States meet criteria for CKM syndrome,¹ and at least 1 in 4 adults have one of these conditions.² Collectively, cardiometabolic diseases remain the leading causes of morbidity and mortality in the US.³

Disparities in Cardiometabolic Disease

Despite advances in health care access, the burden of cardiometabolic disease is not evenly distributed. Significant disparities persist across socioeconomic status, sex, race and ethnicity, and age. An analysis of trends from 1999 through 2018 determined that Mexican American adults had lower rates of optimal cardiometabolic health compared with non-Hispanic White adults, and individuals with lower educational attainment had poorer overall cardiometabolic health.⁴ These findings reflect well-established social gradients in both risk factor burden and clinical outcomes. Individuals positioned at a lower socioeconomic status consistently experience higher exposure to cardiometabolic risk factors, reduced access to preventive services, delayed diagnosis, and suboptimal treatment. Contributing factors include limited education, lower income, reduced access to health care, and neighborhood environments that limit healthy lifestyle choices. Over time, these disadvantages accumulate, contributing to disproportionate disease risk and poorer long-term outcomes.

These disparities are not limited to the United States. The Lancet Regional Health–Europe journal’s series on inequalities and disparities similarly highlights that women, racial and ethnic minorities, older adults, and individuals with mental health conditions face a higher burden of cardiovascular disease and encounter barriers in quality of care, accessibility, and preventive care.⁵ These inequalities are driven in large part by social determinants of health, including household income, education status, access to services, and systemic bias. Addressing these disparities is essential to improving health outcomes, reducing the risk of morbidity and mortality, and advancing health equity.

The Pharmacist’s Role

This is where pharmacists play an important role. As the health care providers at the forefront (and storefront) of accessibility for a patient, pharmacists are uniquely positioned to identify health care gaps, screen for risk factors, provide pertinent counseling, and educate patients. Delivering patient-centered care to these particularly underserved populations with limited access to primary care could significantly reduce disparities. Pharmacists provide tailored clinical services, medication counseling, management of chronic diseases, medication reconciliations, and preventive care through early detection. Cardiometabolic disease is an area where pharmacists contribute significantly through optimizing glycemic control, blood pressure management, and lipid therapy. Accessible walk-in pharmacies and convenient locations enable them to deliver holistic and culturally competent care that considers financial, social, and physical barriers. Pharmacists can monitor disease progression and intervene for better outcomes for patients with cardiometabolic diseases and patients at high risk.

However, barriers remain. Pharmacists may face limitations related to time, resources, integration into care teams, and training in addressing social determinants of health. Evidence suggests that targeted training on social determinants of health can enhance pharmacists’ ability to identify and address factors such as food insecurity, transportation challenges, and medication affordability.⁶ Practical strategies include incorporating screening tools into routine care and strengthening collaboration with social workers and other members of the health care team. These efforts have the potential to improve medication adherence, reduce cost-related barriers, and enhance health literacy.

Conclusion

Without deliberate efforts to reduce these structural and social barriers, inequities in access to quality care will continue to widen, placing more communities at risk. Pharmacists play a critical role in the prevention, early detection, and long-term management of these conditions. Through expanded training, community engagement, and increased awareness, pharmacists can help close gaps in care that disproportionately affect these vulnerable populations. Empowering pharmacists in this role is not only an opportunity to improve individual patient outcomes but also a necessary step toward achieving more equitable health care for all.

REFERENCES

1. Aggarwal R, Ostrominski JW, Vaduganathan M. Prevalence of cardiovascular-kidney-metabolic syndrome stages in US adults, 2011-2020. JAMA. 2024;331(21):1858-1860. doi:10.1001/jama.2024.6892

2. Ostrominski JW, Arnold SV, Butler J, et al. Prevalence and overlap of cardiac, renal, and metabolic conditions in US adults, 1999-2020. JAMA Cardiol. 2023;8(11):1050-1060. doi:10.1001/jamacardio.2023.3241

3. Ahmad FB, Anderson RN. The leading causes of death in the US for 2020. JAMA. 2021;325(18):1829-1830. doi:10.1001/jama.2021.5469

4. O'Hearn M, Lauren BN, Wong JB, Kim DD, Mozaffarian D. Trends and disparities in cardiometabolic health among U.S. adults, 1999-2018. J Am Coll Cardiol. 2022;80(2):138-151. doi:10.1016/j.jacc.2022.04.046

5. Anand SS, Kandasamy S, Marchand M, et al. Reducing inequalities in cardiovascular disease: focus on marginalized populations considering ethnicity and race. Lancet Reg Health Eur. 2025;56:101371. doi:10.1016/j.lanepe.2025.101371

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