Cardiovascular disease remains the world's leading cause of death, with a disproportionate burden falling on low- and middle-income countries. Emerging precision medicine approaches, such as artificial intelligence, multiomics, and digital diagnostics, offer transformational potential for prevention and management. Yet, without equity-centered policies, these innovations risk amplifying disparities. The World Heart Federation (WHF) proposes a framework premised on innovation as a public good and equity as a universal right. Through the World Heart Observatory, Digital Health Roadmap, and Emerging Leaders Program, the WHF operationalizes equity across governance, workforce, and care delivery. Drawing on exemplars from Africa, Latin America, and South/Southeast Asia, we outline implementation strategies and policy levers to translate science into population-level impact. Precision cardiovascular medicine can become the standard for all—but only when designed with equity from inception.