Cardiovascular diseases (CVD), such as coronary artery disease (CAD) and coronary heart disease (CHD), are major global contributors to morbidity and mortality.1 Research has robustly linked traditional risk factors, such as smoking, hypertension, and diabetes, to the progression of CAD and CHD.2 Furthermore, extensive epidemiological studies show the influence of physical inactivity, poor diet, smoking, and family history on heart disease risk. The increasing burden of CHD in many middle-income and low-income countries is largely attributable to socio-economic shifts, longer life expectancies, and the adoption of harmful lifestyles.3 Yet, newer evidence indicates that non-traditional risk factors, especially psychological and socio-environmental stressors, are also potent contributors to the pathogenesis of these conditions.4,5

Historically, economic challenges were deemed to indirectly affect health by limiting one's access to quality healthcare, nutritious food, or opportunities for physical activity. However, the contemporary research perspective posits a more direct and intricate linkage between financial stress and cardiovascular well-being. Financial stress, arising from economic difficulties, correlates with poor health outcomes and is now recognized as a risk enhancer for cardiovascular events.6 Financial stress doesn't just have immediate effects on our health; it can also harm us in the long run.7 Studies have shown that people who face high levels of stress during their midlife years are more likely to face disability in the following years.7 Understanding its impact on CVD like CAD is essential to craft prevention and intervention strategies for at-risk populations. While early studies show a connection between financial stress and CAD/CHD determinants like hypertension and smoking,6 the direct link between financial stress and CAD/CHD onset remains to be clarified. The physiological repercussions of chronic financial strain, manifesting as chronic stress symptoms, range from mild ailments like insomnia to more severe outcomes such as persistent hypertension. Over prolonged periods, these can set the stage for cardiac events, including heart attacks and strokes. Additionally, how financial stress interacts with other psychological factors, such as depression, in CAD/CHD development warrants further exploration.8,9

Several primary studies have been published on the association between financial stress and CAD.6,10,11 In these studies, different terms are used to discuss the stress or worries caused by money troubles. Some common terms include "economic stress," "financial stress," "strain," "hardship," "burden," and "vulnerability." Recognizing disparities and the intricate interplay of financial stress with CAD/CHD is pivotal for holistic public health strategies. The multifaceted relationship between financial stress and CVD challenges the traditional paradigms and mandates an integrative approach to CAD and CHD understanding.6 This systematic review and meta-analysis aims to synthesise the existing evidence, highlighting the role of financial stress as a determinant of cardiovascular health.