Over the past 50 years, the development and implementation of preventive public health strategies, and medical advances in managing and treating cardiovascular disease (CVD), have resulted in significant declines in CVD morbidity and mortality. However, improvements have slowed in recent years, and in some countries, progress is now reversing. Today, CVD remains one of the most significant health concerns confronting European Union (EU) countries, and beyond. CVD remains the leading cause of morbidity and mortality in the EU, accounting for one‑in-three of all deaths (1.7 million deaths in 2022) and affecting an estimated 62 million people.
EU countries differ vastly in the magnitude of cardiovascular mortality, with Central and Eastern European countries having higher mortality rates compared to Western and Southern European countries. Regional inequalities in CVD mortality across the EU have been further exacerbated by COVID‑19. Countries with high pre‑pandemic CVD mortality, such as Bulgaria, Romania, Latvia and Lithuania, saw increases in age‑standardised mortality rates between 2019 and 2021, while those with lower mortality experienced smaller rises or continued declines, with Luxembourg and Portugal observing the greatest declines.
In most EU countries, the mortality rate from circulatory diseases is about 26‑60% higher in men than in women. Premature mortality (under age 65) is over three times higher in men. Regardless of geography or gender, people living with CVD report lower quality of life than their peers without CVD, including reduced well-being, poorer physical health, and worse mental health. These disparities reflect real gaps in access, quality, and system performance.
Aside from the human costs, CVD accounts for a significant share of healthcare expenditures in the EU. As of 2021, the total economic burden of CVD in the EU has been estimated at EUR 282 billion annually, amounting to approximately 2% of the region’s gross domestic product. This substantial financial commitment is distributed across several key components: direct healthcare costs, social care costs, informal care, and productivity losses. On a per capita basis, CVD-related costs averaged EUR 630 per EU citizen. The combined burden of healthcare expenditures and informal care costs is significantly greater for CVD than for cancer in the EU, sometimes even doubling them, highlighting the considerable burden on people living with CVD, as well as their families and caregivers.
All EU countries are ageing, with the share of people aged 65 and over expected to rise from 22% in 2024 to 29% by 2050. This demographic shift is expected to increase the burden of CVD, with estimates suggesting as much as a 90% rise in CVD prevalence in Europe between 2025 and 2050.
On top of demographics, a mix of factors increase the risk of CVD. More than three‑quarters of CVD deaths in the EU are linked to modifiable risks, with metabolic factors – such as hypertension, diabetes and obesity – accounting for 68%, behavioural risks for 37%, and environmental risks contributing 18%. Over the past decade, exposure to metabolic risks has largely risen or stayed high, while behavioural and environmental risks show mixed trends. Of the 15 CVD risk-related metrics presented in this report, eight have worsened, and the remaining seven indicate high levels of population exposure. One‑in-five (22%) people living in the EU lives with hypertension, another one‑in-seven live with obesity (15%), and one‑in‑13 (8%) live with diabetes. Depression and severe mental illness – including schizophrenia or bipolar disorder – are associated with increased risk of myocardial infarction, stroke, angina and coronary heart disease. Close to a third (27%) of adults aged 45 and over report at least four depressive symptoms.
Screening is key for managing conditions like hypertension, diabetes and dyslipidaemia, which, if not controlled, can lead to cardiovascular events with more severe complications for patients. Despite the accessibility of blood pressure screening and given that hypertension is a major CVD risk factor, more than 30% of adults aged 45 to 54 in the EU have not had a measurement in the last year, and about 6% have not had a measurement in the past five years. Cholesterol and blood glucose screening is lacking, with over 10% of adults aged 45 to 54 in the EU not having had a test in the past five years. Screening alone is not sufficient – timely follow-up care, including diagnosis, treatment, and patient support, is essential to translate early detection into improved outcomes.
Health promotion activities can have substantial impacts by targeting people already living with CVD, and there are opportunities to better reach people living with CVD with the advice that can help them improve on modifiable risk factors and effectively manage their conditions. Confidence in self-management among people aged 45 and older with CVD varies more than three‑fold across countries. Strong primary care can also prevent costly and avoidable CVD-related hospital admissions. In 2023, EU countries averaged 232 avoidable hospital admissions per 100 000 people for chronic health failure, with rates varying more than four‑fold. Matching the lowest OECD country rate for CVD admissions could save the EU EUR 45 billion – around 16% of total CVD spending in 2021.
Hospitalisation remains common for CVD patients, who are twice as likely to be hospitalised as others. One in four CVD patients aged 45+ were hospitalised in the last year, despite downward trends in hospitalisation. In 2023, 14% of hospital discharges in Europe were related to CVD, requiring either planned procedures or acute care. However, the effectiveness of hospital care and the likelihood of survival and readmission for CVD patients vary across the EU. Post-discharge care, including medication adherence, is critical but often drops sharply after discharge. Data from 14 EU countries show that 24% of stroke patients and 33% of chronic heart failure patients are readmitted, with mortality rates of 16% and 24%, respectively, after hospital discharge. Effective co‑ordination of post-acute care could reduce medium and long-term mortality and morbidity.
Across Europe, national policies to address CVD vary widely, ranging from broad national plans to disease‑specific programmes. These policies mainly address prevention across the life course, early detection, diagnosis and treatment, rehabilitation, care continuity, and improved quality of life. However, tackling inequalities and promoting patient-centred care remain less emphasised within these initiatives.
Preventive care and early risk detection, through health checks and targeted prevention initiatives, are effective and cost-efficient to identify and manage cardiovascular risk factors, particularly for disadvantaged populations. However, reaching people in vulnerable situations and sustaining engagement with them remains a challenge. Low health literacy further limits timely care and adherence, highlighting the need for targeted education and public training, including automated external defibrillator use, to improve survival after cardiac events.
Digital health technologies are increasingly shaping the prevention and management of CVD. Tools such as electronic health records (EHRs), clinical decision support systems, telemedicine platforms, mobile health applications, and wearable monitoring devices enable the systematic collection of health data and contribute to more effective CVD policies. Despite these advantages, the adoption of such technologies remains limited across the EU. Less than half of surveyed countries reported using EHRs to assess CVD burden and outcomes. Similar challenges apply to wearable technologies: only three EU+2 countries (Czechia, France and Norway) reported having national policies promoting their adoption, and just one country (France) reported having the infrastructure to integrate data from wearables into EHR systems. In parallel, AI and machine learning tools are rapidly expanding, with more than 1 000 AI algorithms approved for medical use by the US FDA by the end of 2024, with cardiology among the top fields (comparable figures in the EU context are not currently available).
Improving cardiovascular and cerebrovascular health outcomes requires co‑ordinated, people‑centred approach from prevention and early detection to post-acute support. Multidisciplinary programmes, home/clinic-based follow-up and self-management reduce mortality and hospitalisation. People‑centred approaches, shared decision making, and self-management improve patient experiences and health outcomes but are not yet widely adopted in Europe. Investments in health literacy, discharge planning, rehabilitation, and early supported discharge can accelerate recovery and expand home‑based care opportunities. Breaking down administrative silos, aligning financial incentives, and enhancing primary care systems improve access, care continuity, and quality in cardiovascular care.