Objectives To evaluate the role of community pharmacy in the prevention of cardiovascular disease (CVD) among minority ethnic groups and to identify key barriers and facilitators influencing engagement with pharmacy-based CVD prevention services. Design Systematic review using thematic synthesis to analyse both qualitative data and narratively synthesised quantitative data taking a convergent data synthesis approach. Searches were conducted from inception to 16 October 2024 across CINAHL Ultimate (EBSCOhost), EMBASE (Ovid), PubMed (NLM), Scopus (Elsevier) and Web of Science (Clarivate), supplemented by Google Scholar for grey literature and backward and forward citation tracking to identify additional studies. Setting Community pharmacy settings across multiple countries, including the UK and international contexts. Participants Minority ethnic groups accessing community pharmacy services and community pharmacy professionals involved in delivering CVD prevention interventions. Interventions Community pharmacy-based CVD prevention interventions, specifically services addressing CVD risk factors. Outcome measures Outcomes comprised qualitative insights, including barriers and facilitators to engagement with community pharmacy-led CVD prevention services. Results Twenty-three studies met the eligibility criteria. Five overarching themes were identified: trust, systemic barriers, culturally tailored language, cultural and religious influences and family and social networks. Community pharmacies undertook varied CVD-related roles, most commonly CVD screening and diabetes management with additional contributions to smoking cessation, weight and lipid management, health promotion and medication adherence. Community pharmacies showed potential to support CVD prevention among minority ethnic groups. However, engagement was limited by language barriers, cultural beliefs, lack of trust in healthcare providers and organisational constraints such as time pressures and limited training. Facilitators included culturally tailored interventions, language concordance and strong pharmacist-patient relationships. Conclusions Evidence from the UK remains limited, highlighting a need for further research into the role of community pharmacy in reducing CVD disparities among minority ethnic groups. International evidence suggests significant potential for pharmacy-based interventions, but improved cultural competence, targeted service design and greater awareness of determinants of equitable healthcare are essential. Future research should focus on optimising culturally responsive pharmacy-led CVD prevention strategies. PROSPERO registration number CRD42024579766.