Abstract Body: Background: Cardiovascular disease (CVD) is the leading cause of premature mortality in low- and middle-income countries (LMICs). However, the scale, distribution and trajectory of international development assistance for CVD have not been systematically characterized. Understanding these patterns is essential for informing targeted policy interventions and optimizing resource allocation.
Hypothesis: Development assistance for CVD is limited, concentrated among a few donors and recipients, and marked by temporal volatility.

Methods: We examined development assistance projects reported to the Organisation for Economic Co-operation and Development (OECD) Creditor Reporting System between 2007 and 2023. We identified CVD-related projects using a keyword-based search strategy, translated across 21 languages. We analyzed funding trends across 34 donors and 65 recipients, including countries and regions. Joinpoint regression was applied to identify statistically significant changes in disbursements over time.

Results: Of the 4,507,692 projects analyzed, 815 were identified as CVD-related. These received US$434.98 million in disbursements, representing 0.008% of all international development assistance funding. The three largest donors, including the United Kingdom (US$71.62 million), the Wellcome Trust (US$70.17 million), and the United States (US$48.16 million), accounted for 43.7% of total CVD-related aid. The three largest recipient countries were Uganda (US$50.71 million), Uzbekistan (US$41.77 million), and Kenya (US$30.85 million). Funding declined significantly during the COVID-19 pandemic to US$9.99 million in 2019 and US$9.36 million in 2020, then rebounded to US$63.99 million in 2023. Joinpoint analysis identified four significant transition points (2011, 2014, 2017, 2020), with an average annual percent change of US$37.03 million (95% CI: US$15.45-67.15 million; p < 0.001).

Conclusions: Between 2007 and 2023, CVD-related development assistance to LMICs remained exceedingly low, fragmented, and donor-dominated. These findings highlight the urgent need for global health donors to elevate CVD within funding priorities, expand support to LMICs, and commit to equitable financing strategies.