Global Landscape of Cardiovascular Research: A Continental Bibliometric Analysis Standardized by Population and Physician Density

BackgroundCardiovascular diseases (CVDs) remain the leading cause of global mortality. Despite rising research output, geographic disparities persist in the production and dissemination of scientific knowledge. ObjectivesTo evaluate cardiovascular research productivity across world regions by normalizing publication output to population size and physician density, and to quantify disparities using Z-scores. MethodsA comprehensive bibliometric analysis was conducted using Medline/PubMed to identify CVD-related publications across all 193 UN-recognized countries. Data were standardized using 2025 population estimates and WHO-reported physician density. Two standardized metrics were computed : publications per million population and publications per physician density. Z-scores were calculated to assess research productivity relative to global means. ResultsA total of 474,599 CVD publications were identified. Europe led in absolute volume (34.2%), followed by the Americas (30.7%) and Asia (25.8%). When adjusted per population density, Oceania (428.6), North America (336.7), and Western Europe (268.1) ranked highest. In contrast, Asia (15,917.3) and Sub-Saharan Africa (10,209.2) demonstrated the highest efficiency when adjusted for physician density. Z-score analysis revealed that Oceania (Z = +1.80), North America (Z = +1.25), and Western Europe (Z = +0.83) outperformed other regions in per capita productivity. However, when adjusted for physician density, Asia (Z = +2.18) and Sub-Saharan Africa (Z = +1.17) emerged as unexpectedly efficient despite limited workforce capacity. At the national level, Canada (Z = +2.44) and Japan (Z = +1.37) excelled per capita, while the United States (Z = +2.72) and Japan (Z = +1.83) led in physician-adjusted output. ConclusionMajor geographic disparities exist in cardiovascular research output. Standardization by population and physician densities reveals high-efficiency zones in lowerresource settings, challenging assumptions about global scientific productivity. Strategic investment in underrepresented regions is essential to foster equitable knowledge generation and strengthen global cardiovascular health.