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Cardiovascular diseases (CVDs) have been the leading cause of death in China. Depression and anxiety are recognized as significant risk factors for poor prognosis and disability among Chinese CVD patients. However, these mental health conditions have received limited clinical attention in the context of CVD management. To date, comprehensive national epidemiological data on the prevalence of depression and anxiety in cardiovascular clinics (CVCs) in China are lacking. The present study aims to describe the prevalence, recognition and therapeutic inequity in CVCs so as to improve the overall health outcomes of CVD patients. A multicenter, cross-sectional study was conducted across secondary and tertiary hospitals in China (January 2021 to December 2022), enrolling 1049 CVD patients from CVCs consecutively. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Sociodemographic and clinical data were collected via standardized questionnaires. Risk factors were analyzed by multivariable logistic regression, meanwhile recognition rates and treatment inequities were systematically evaluated. The pooled prevalence of depression and anxiety were 61.4% and 53.4% respectively, with 23.9% exhibiting moderate-to-severe symptoms. The multivariable logistic regression analyses disclosed that residing in South Central China, usual activities impairment, as well as experiencing pain or discomfort in daily life were associated with the presence of both depression and anxiety among patients in CVCs. Alarmingly, only 41.5% of depressed patients and 44.1% of anxious patients were recognized; and fewer than 50% accessed guideline-recommended interventions (psycho-education or medications). Patients residing in South Central China, having moderate or severe mental symptoms and having anxiety and depression comorbidity were more likely to be recognized and treated by cardiologists. This first national study to demonstrate the "high burden-low care" paradox in Chinese CVCs highlights systemic gaps in mental health integration. Urgent implementation of collaborative care models is warranted, prioritizing standardized screening protocols and equity-focused interventions for vulnerable subgroups. These findings provide pivotal evidence for advancing Chinese CVD clinical guidelines to address the mental health crisis in cardiology.Trial registration: The trial was registered with ClinicalTrials.gov under the identifier NCT03225586 (Registration Date: 2017-07-19).