A sweeping analysis of nearly 2,000 scientific publications has revealed a major transformation in how researchers explain cardiovascular disparities affecting minority populations. Earlier studies tended to search for answers in genes, diet, obesity, migration histories and individual lifestyle choices. More recent work, however, increasingly points toward discrimination, racism, stigma, unequal access to health care and the chronic psychological burden of living as a member of a marginalised group. The review suggests that social conditions are not merely background circumstances surrounding cardiovascular disease. They may become biologically embedded, altering stress physiology and the autonomic nervous system in ways that can increase vulnerability to hypertension, metabolic illness and cardiovascular events.
The study, published in Public Health in Practice, is a scientometric review—a form of research that maps the structure and evolution of an entire scientific field rather than testing a single medical treatment or biological hypothesis. Alessandro Carollo and colleagues searched the Scopus database for studies containing terms related to heart rate, heart rate variability, the vagus nerve, parasympathetic and autonomic activity, cardiovascular disease or hypertension, together with terms concerning racism, prejudice, discrimination and minority identities. Their search identified 1,945 publications published between 1953 and 2024, along with 93,703 references cited by those papers. By examining which papers were cited together, the researchers reconstructed the intellectual landscape of research into cardiovascular and autonomic functioning among minority groups.
The team used bibliometrix, an analytical package for the R programming language, to examine countries, authors, journals and keywords, then imported the records into CiteSpace, software designed to visualise emerging research patterns. CiteSpace accepted 88,020 references—93.74 per cent of the total—because they contained the bibliographic information required for analysis. The resulting document co-citation network contained 2,873 nodes, representing publications, and 7,636 links, representing connections created when papers were cited together. Its modularity score was 0.9643, indicating that the network divided into clearly recognisable thematic communities, while its weighted mean silhouette score was 0.9897, suggesting that the publications within each cluster were highly coherent and distinct from neighbouring clusters.
Nine major themes emerged. The earliest centred on genetics, with a mean publication year of 1997, and reflected attempts to explain hypertension and cardiovascular risk through inherited biological differences. A later cluster focused on diet, including lactose intolerance and the possibility that lower consumption of dairy products and calcium-rich foods might contribute to chronic disease disparities. Other early themes addressed obesity, sleep-disordered breathing and metabolic risk. Kidney dysfunction and cardiovascular disorders formed another influential cluster, reflecting evidence that some ethnic minority populations face higher risks of kidney disease in the context of cardiovascular and metabolic illness, as well as barriers to obtaining high-quality care.
The scientific map then moved toward a more complicated understanding of cardiovascular risk. One major cluster examined racism and cardiovascular disease among African American populations, distinguishing institutional, interpersonal and internalised forms of racism. Across the literature, associations between racial discrimination and cardiovascular risk were positive but not always consistent, a pattern that researchers say reflects the complexity of measuring both exposure and physiological consequences. Another cluster explored cardiovascular health among ethnic minority and migrant populations across different countries. Its central message was that broad comparisons between “minority” and “majority” populations can conceal crucial differences in migration history, national policy, socioeconomic conditions, cultural background and country of origin.
This shift is especially important because cardiovascular risk is shaped by interacting biological and social processes. Chronic exposure to stress can activate the sympathetic nervous system, which prepares the body for threat by increasing heart rate, constricting blood vessels and raising blood pressure. Repeated or prolonged activation may contribute to vascular damage, hypertension and metabolic dysregulation. At the same time, stress can influence sleep, inflammation, physical activity, diet and engagement with medical care. The review describes evidence linking elevated psychosocial stress with physiological dysregulation and hypertension, while highlighting heart rate variability as an important measure of autonomic function. Heart rate variability refers to the naturally occurring variation in the interval between successive heartbeats. Greater vagally mediated variability is often associated with flexible regulation of cardiovascular and emotional responses, although its meaning depends on the physiological context in which it is measured.
One intriguing pattern identified in the underlying literature is the so-called cardiovascular conundrum. Some ethnic, gender and sexual minority groups have displayed both increased sympathetic vasoconstriction and elevated vagally mediated heart rate variability—signals that might appear contradictory if interpreted in isolation. The authors suggest that this combination could represent a physiological signature of constant coping with discrimination, in which the body maintains strong regulatory capacity while simultaneously remaining prepared for social threat. The finding does not prove that discrimination causes a particular autonomic profile, and the scientometric review was not designed to establish clinical mechanisms. Instead, it identifies a recurring research direction: the possibility that chronic efforts to manage stigma and unfair treatment leave measurable traces in cardiovascular regulation.
The analysis also shows that sexual and gender minorities have become a distinct area of research, with a cluster averaging 2009 in publication year. Studies in this group report poorer mental and physical health, alongside elevated cardiovascular and metabolic risks, among lesbian, gay and bisexual populations compared with heterosexual people. Researchers increasingly attribute these disparities to minority stress, a framework describing the chronic burden created by stigma, discrimination, concealment pressures, rejection and internalised negative beliefs. The relevance of this evidence extends beyond sexual and gender minorities. Because these groups do not differ from majority populations in the basic genetic or dietary factors traditionally invoked to explain health disparities, their comparable patterns of vulnerability provide an important challenge to explanations based solely on biology or lifestyle.
The review’s citation-burst analysis identified ten publications that experienced sharp increases in attention. The most prominent was a report examining research gaps and future directions concerning LGBTQ+ health across the lifespan, with a citation burst of 8.50 between 2013 and 2019. Other highly influential publications included an American Heart Association scientific statement on cardiovascular health in African Americans and a presidential advisory identifying structural racism as a fundamental driver of health disparities. These bursts suggest that the field’s centre of gravity has continued to move toward social determinants, structural conditions and the physiological effects of discrimination. Yet the researchers warn that the evidence base remains uneven. Sexual and gender minorities, neurodivergent people and other under-represented populations have received far less attention than some ethnic and racial groups, while the literature itself is dominated by research conducted in the United States.
The authors emphasise that their findings should be interpreted as a map of influential research domains, not as proof that any intervention prevents cardiovascular disease. Citation analyses favour older and frequently cited publications, potentially obscuring newer discoveries, although the use of citation bursts helped identify rapidly emerging topics. The reliance on Scopus also means that studies indexed elsewhere may have been missed. Nevertheless, the overall trajectory is clear: cardiovascular disparities are increasingly being understood as the product of an interaction between biology and social experience. The researchers argue that public-health surveillance should collect more inclusive information about sexual orientation, gender identity and other relevant social characteristics; clinical assessments should consider chronic discrimination and minority stress alongside conventional risk factors; and prevention efforts should address structural barriers rather than placing the burden entirely on individuals. The review’s central warning is both scientific and political: unequal social environments can become embodied, and reducing cardiovascular inequality may require changing those environments as much as changing personal behaviour.
Subject of Research: Cardiovascular and autonomic nervous system functioning, health disparities, minority stress, discrimination and racism in minority populations
Subject of Research: Medicine
Article Title: Research on cardiovascular functioning in minority groups: From biological explanations to social and discrimination-related determinants
Article References: Carollo, A., Fong, S., Ottaviani, C., Baiocco, R., Laghi, F., & Esposito, G. (2026). Research on cardiovascular functioning in minority groups: From biological explanations to social and discrimination-related determinants. Public Health in Practice, 12, Article 100826. https://doi.org/10.1016/j.puhip.2026.100826
Image Credits: AI Generated
DOI: 10.1016/j.puhip.2026.100826
Keywords: cardiovascular health disparities, minority stress, racism and health, autonomic nervous system, heart rate variability, discrimination, hypertension, sexual and gender minorities, public health
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SCIENMAG. (August 28, 2026). Cardiovascular Health in Minority Groups: From Biology to Social and Discrimination Drivers. https://scienmag.com/cardiovascular-health-in-minority-groups-from-biology-to-social-and-discrimination-drivers/
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