CARDIO4Cities: A roadmap for improving urban cardiovascular health

This roadmap reviews CARDIO4Cities, a whole-of-city approach designed to reduce cardiovascular risk and disease at population level. As urbanization accelerates globally - with 68% of the global population projected to live in cities by 2050 - cities across income settings face a growing burden of cardiovascular disease, yet often lack operational models that translate evidence into scalable action. CARDIO4Cities responds to this gap by combining a simple, standardized population-health framework with locally adaptable implementation pathways that can be embedded within existing city systems. The approach is organized around six reinforcing pillars: quality and coordination of Care, Access to early diagnosis and management of cardiovascular risk factors, policy Reform, Data and technology, Intersectoral collaboration, and local Ownership. Rather than relying on new parallel infrastructures, CARDIO4Cities integrates evidence-based interventions into routine health services and leverages non-traditional community and private-sector actors, enabling replication across cities with varying levels of health-system maturity and resources. This document provides city health officials and their partners with a step-by-step implementation pathway, including governance structures, target-setting frameworks, intervention design processes, monitoring systems, and scaling strategies. Evaluations from the first three implementation cities-São Paulo (Brazil), Dakar (Senegal), and Ulaanbaatar (Mongolia)-demonstrated significant improvements in hypertension control and reductions in acute cardiovascular events within one to two years. Modeling projected that, without further CARDIO4Cities interventions, 2.7-7.9% of premature deaths would be averted over the subsequent decade, at costs meeting WHO-CHOICE cost-effectiveness thresholds. These results, achieved in diverse geographic, economic, and health-system contexts, illustrate the transferability of the model across income settings. Since standardization of the approach, CARDIO4Cities has expanded to more than 40 cities worldwide, including major cities in Europe and the Americas, equipping city leaders with operational guidance to implement evidence-based cardiovascular population health programs adapted to local contexts and resources. We position CARDIO4Cities as a replicable and scalable model for improving cardiovascular population health across diverse urban contexts, from resource-constrained cities initiating basic risk-factor detection to data-rich cities advancing toward precision population health.