Everyone knows at least one person who has suffered a heart attack or stroke – it is no wonder, as cardiovascular diseases (CVDs) are the leading cause of death globally. In Europe alone, more than 4 million deaths per year are attributed to CVD, which is more than a third of all deaths on the continent[1].  85% of CVD-related deaths are caused by heart attacks and strokes[2], which are manifestations of atherosclerotic cardiovascular disease (ASCVD), and are associated not only with high mortality, but also with high rates of hospitalisation, significant disability, and increased healthcare costs. Research has demonstrated that the implementation of comprehensive primary and secondary prevention programs by governments could potentially prevent up to 80% of these deaths[3].

CVD mortality declined in the past 50 years due to innovative medicines and expanding knowledge of CVD management and treatment[4]. However, around the years 2000-2005, there was a turning point where medical interventions appear to have reached their limit in terms of population-level impact. Additionally, since 2015, we have been observing a plateau in CVD mortality in most countries across the globe[5]. In some, we even witness CVD mortality on the rise again, mainly due to inadequate prevention of atherosclerotic events. At the same time, prevalence and incidence remain the same or have decreased slightly during the same period.

The risk of developing CVD remains very high, and there is a pressing need for healthcare systems to take action in identifying, treating, and managing patients with CVD.

There are five main modifiable risk factors for cardiovascular events: high LDL cholesterol (LDL-C), hypertension, smoking, high blood glucose, hyperglycaemia, and obesity. Risks can be decreased by introducing lifestyle changes and following medical guidelines, including those for populations who have suffered a CVD event, and recommending specific targets for risk factor treatment.

However, even with the availability of lipid-lowering treatments, a significant proportion of patients in Europe fail to reach their LDL-C goals, and healthcare professionals frequently fail to detect and address CVD in a timely manner.

Investment in prevention, early detection and screening are crucial to reducing the risk of cardiovascular diseases.

We compiled a set of CVD data across 22 European countries to see how CVD trends have developed over time, the existing disparities between countries and what key actions can be taken to make a positive difference.

The CVD dashboards show that most European countries (14 out of 22) have implemented at least 4 prevention programmes in place with four countries having 5. These programmes include tobacco, alcohol and obesity prevention, physical activity recommendations as well as hypertension guidelines. It is evident that a healthy lifestyle alone cannot solve the problem. 

Therefore, countries need to set metrics and targets for cardiovascular outcomes along with well-defined pathways to assist patients in achieving their targets. They need to allocate dedicated budgets behind these targets and create and implement national cardiovascular health plans, which apart from the identification of risk factors and screening policies, should also include management of the conditions and a focus on treatment adherence.

It is crucial to diagnose people with CVD as early as possible to prevent complications and save downstream costs for healthcare systems.

In European countries, CVDs are one of the biggest cost drivers for the healthcare systems and the economy – the burden is also high on caregivers and impacts societal productivity. Secondary prevention programmes and ensuring appropriate follow up for patients who have experienced a heart attack or stroke are critical not only for saving the lives of European citizens but also for reducing healthcare costs over the long term. Primary care can significantly contribute to this effort by conducting cardiovascular health checks for populations at risk. These health checks can screen for the 5 main risk factors and can be conveniently performed in the family doctor’s office. They are quick, easy to implement and cost-effective. What we urgently need is political commitment to make these policies a reality and to shift government’s mindsets towards investing in health as a foundation for a resilient and prosperous society.

We support the development of a European Cardiovascular Health Plan by the Commission and the implementation of national CV Health strategies in European countries.

Observed mortality rates that are attributed to CVD are almost twice as high as those from cancer, respiratory diseases, injuries, and other non-communicable diseases (NCDs) (reference 1). Although CVD is the No. 1 killer in Europe for both men and women, most of the countries lack cardiovascular health plans. In 2022, the European Commission published the European Beating Cancer Plan [6] that aims to tackle the entire disease pathway. Although only 20% of cancers are preventable, the European stakeholders mobilised (and rightly) to address this – imagine the impact that a European Cardiovascular Health Plan would have given that 80% of CVDs are preventable.

Addressing health inequalities in CVD remains a critical issue for healthcare systems, and investing in effective policies is essential for promoting greater equity in Europe

There are significant health inequalities happening in Europe in the cardiovascular space with Eastern European countries experiencing higher CVD burden and higher mortality rates than Western European countries. Women bear a greater CVD burden than men, receive diagnosis later than men, and are subject to different treatment approaches. Additionally, significant disparities exist between populations with varying socioeconomic backgrounds. The European Union and European healthcare systems need to address this problem by investing in the right policies such as the cardiovascular health checks for those who need them at primary care level.

There is a unique and growing momentum for CVD in Europe

In 2021, the European Commission published the “Healthier Together EU initiative on Non-communicable Diseases” which includes recommendations for CVD policies to be implemented in Member States and identifies priorities of action[7]. It also offered a total funding of 53 million euros for initiatives for CVD and diabetes via its 2022 EU4Health initiative. Additionally, in 2022, the European Alliance for Cardiovascular Health (EACH) published a cardiovascular health plan for Europe to reduce premature and preventable deaths in the region and improve access to high-quality cardiovascular risk assessment and multidisciplinary care pathways for all[8]. What we need now is for the EU institutions to set common targets to guide the Member States in implementing the right policy tools to achieve such targets at the national level.

The CVD policy dashboards are a valuable tool for assessing the various cardiovascular policy landscapes in Europe, and can aid in identifying gaps that require urgent attention to tackle CVD and improve the health and quality of life for patients with cardiovascular disease.

The dashboards were developed and funded by Amgen and made available to EFPIA for dissemination on their Cardiovascular Health Platform.

[1] ESC Cardiovascular Realities 2022: https://www.flipsnack.com/escardio/esc-cardiovascular-realities-2022/full-view.html

[2] World Health Organization Fact Sheets: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

[3] World Health Organization. https://www.who.int/news-room/questions-and-answers/item/cardiovascular-diseases-avoiding-heart-attacks-and-strokes

[4] Mensah GA, Wei GS, Sorlie PD, et al. 2017. Decline in Cardiovascular Mortality: Possible Causes and Implications. Circ Res 120(2): 366-80

[5] The Institute for Health Metrics and Evaluation. 2020. JACC: Cardiovascular Disease Burden, Deaths Are Rising Around the World. https://www.healthdata. org/news-release/jacc-cardiovascular-disease-burdendeaths-are-rising-around-world

[6] European Commission. Europe’s Beating Cancer Plan. https://health.ec.europa.eu/system/files/2022-02/eu_cancer-plan_en_0.pdf 

[7] European Commission. Healthier Together – EU non-communicable diseases initiative.  https://health.ec.europa.eu/non-communicable-diseases/healthier-together-eu-non-communicable-diseases-initiative_en

[8] European Alliance for Cardiovascular Health (EACH). A European Cardiovascular Health Plan: The need and the ambition. https://www.cardiovascular-alliance.eu/wp-content/uploads/2022/05/EACH-Plan-Final_130522.pdf