COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF THE REGIONS on an EU cardiovascular health plan: the Safe Hearts Plan
Date: 2025-12-16
Institutions: Directorate-General for Health and Food Safety, European Commission
Subjects: EU action, cardiovascular disease, digitisation, disease prevention, e-Health, health care, innovation, medical research, public health, therapeutics

EN 

  EN 

   EUROPEAN COMMISSION  Strasbourg, 16.12.2025  COM(2025) 1024 final  COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF THE REGIONS on an EU cardiovascular health plan: the Safe Hearts Plan  
 
 
The  EU  cardiovascular  health  plan  (Safe  Hearts  Plan)  is  a  strategic  response  to  the  EU’s 
leading health challenge. Its aim is to deliver tangible benefits for citizens, health systems and 
society  through  a  focused  set  of  ambitious,  high-impact  actions.  The  Safe  Hearts  Plan  is 
centred on three pillars – prevention, early detection and screening, and treatment and care 
(including rehabilitation) – and supported by three cross-cutting themes on digital innovation, 
research and knowledge, and tackling inequalities. It seeks to strengthen national policies 
while adding clear EU value. 

1.  IMPROVING CARDIOVASCULAR HEALTH IN THE EU: THE CHALLENGES AHEAD  

Introduction  

Cardiovascular  diseases  remain  the  biggest  public  health  challenge  in  the  EU  despite 
advances  in  their  prevention  and  management1.  They  are  the  leading  cause  of  death  and 
disability in the EU, claiming 1.7 million lives every year2 and affecting around 62 million 
people in many ways that go beyond just physical symptoms. The economic cost exceeds EUR 
282 billion per year, including EUR 47 billion in lost productivity3. 

Besides this heavy societal and economic burden, there are significant geographical, gender, 
disability-related  and  socio-economic  inequalities  that  reinforce  the  need  to  intervene 
decisively  at  EU  and  national  level  for  the  benefit  of  present  and  future  generations. 
Cardiovascular death rates are nearly 6.3 times higher in some Member States than in others4. 
Within  Member  States,  there  is  a  higher  prevalence  of  cardiovascular  diseases  and  related 
mortality  in  lower  income  and  education  population  groups.  Cardiovascular  diseases  occur 
frequently together with conditions like diabetes and obesity, significantly impacting people’s 
quality  of  life.  It  is  necessary  to  pool  resources,  knowledge  and  experience,  as  well  as  to 
maximise synergies and economies of scale at EU level.  

Without  decisive  and  coordinated  EU  action,  the  burden  of  cardiovascular  diseases  will 
continue to rise, undermining the health and well-being of future generations, straining health 
systems and weakening the EU’s economic resilience. Between 2025 and 2050, the prevalence 
of cardiovascular diseases is projected to rise by 90%, with deaths increasing by 73.4% to reach 
an estimated 35.6 million in 2050 (up from 20.5 million in 2025)5. Ischaemic heart disease6 is 
expected to remain the leading  cause of cardiovascular deaths  and  high  blood  pressure will 
remain the main risk factor.  

1  Cardiovascular  diseases  affect  the  heart  and  blood  vessels. They  include  heart  attacks,  stroke,  heart  failure, 
ischaemic heart diseases, abnormal heart rhythms, structural heart diseases, cardiomyopathy and congenital heart 
diseases. 
2 Unless stated otherwise, the source of the figures is the OECD report (2025) ‘The state of cardiovascular health 
in the EU’ - Full Report: The State of Cardiovascular Health in the European Union | OECD. 
3 In 2021 alone, 256 million working days and 1.3 million working years were lost due to illness and disability, 
and premature deaths, respectively.  
4 Cardiovascular diseases statistics – Statistics Explained – Eurostat.  
5 Global burden of cardiovascular diseases: projections from 2025 to 2050 - PubMed. 
6 Ischaemic heart disease is also known as coronary heart disease or coronary artery disease. 

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The Safe Hearts Plan responds directly to the calls from the Member States7 and the European 
Parliament8  for  stronger  action  at  EU  level  and  is  based  on  contributions  received  through 
various consultation activities9. It focuses on targeted impactful actions, with evidence-based 
EU added value for citizens, governments and stakeholders, to support the Member States to 
tackle one of the biggest collective health challenges.  

The Safe Hearts Plan is part of the European Health Union10 and thus exploits synergies with 
strategic initiatives and builds on actions linked to non-communicable diseases (NCDs), such 
as the ‘Healthier Together’ – NCDs initiative11, the Europe’s Beating Cancer Plan12, the EU 
Cancer Mission13, the comprehensive approach on mental health14, the Zero Pollution Action 
Plan15 and the Strategy for European Life Sciences16, as well as the legislative frameworks on 
the European Health Data Space17 and on substances of human origin18, the proposed revision 
of the legislation on pharmaceuticals and medical devices, the proposed Critical Medicines Act 
and  the  proposal  for  a  European  Biotech  Act19.  It  also  builds  on  and  strengthens  the  EU’s 
ongoing support to Member States20 and stakeholders to improve cardiovascular health.  

The Safe Hearts Plan will support Member States’ progress towards Sustainable Development 
Goal 3.4 (to reduce premature mortality from cardiovascular diseases, diabetes and other key 
NCDs through prevention and treatment, by one third by 2030).  

The Safe Hearts Plan is supported by the evidence provided in the recently published report on 
‘The State of Cardiovascular Health in the EU’21. This OECD report, which is co-funded by 
the EU4Health programme22, builds on a longstanding collaboration between the OECD and 
the  Commission  to  monitor  and  improve  population  health,  including  through  the  State  of 

7  Council  of  the  European  Union,  Council  Conclusions  on  the  Improvement  of  Cardiovascular  Health  in  the 
European Union, ST 15315/24 INIT. al x. 
8 MEP Cardiovascular Health Group and European Parliament, Report  on non-communicable diseases (NCDs), 
A9-0366/2023, adopted 13 December 2023.|  
9 See for instance, the Have your say. 
10 European Health Union: https://commission.europa.eu/topics/public-health/european-health-union_en.  
11 Healthier together – EU non-communicable diseases initiative - Public Health. 
12 Communication from the Commission to the European Parliament and the Council, Europe’s Beating Cancer 
Plan, COM(2021) 44 final.  
13 EU Mission: Cancer - Research and innovation - European Commission. 
14 Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions, A comprehensive approach to mental health, COM(2023) 
298 final. 
15 Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social  Committee  and  the  Committee  of  the  Regions,  Pathway  to  a  Healthy  Planet  for All  EU Action  Plan: 
'Towards Zero Pollution for Air, Water and Soil' COM (2021)400. 
16 Strategy for European Life Sciences - Research and innovation. 
17  Regulation  (EU)  2025/327  on  the  European  Health  Data  Space  and  amending  Directive  2011/24/EU  and 
Regulation (EU) 2024/2847. 
18 Reform of the pharmaceutical legislation and measures addressing antimicrobial resistance, COM(2023) 190 
final; Medical Devices -  Public Health - European Commission; Critical medicines act - Public Health - European 
Commission; and New EU rules on substances of human origin - Public Health. 
19 Biotech Act. 
20 For instance through the Joint Actions: JACARDI, PreventNCD and JARED. 
21 OECD report (2025) ‘The state of cardiovascular health in the EU’ - Full Report: The State of Cardiovascular 
Health in the European Union | OECD. 
22 EU4Health programme 2021-2027 – a vision for a healthier European Union - Public Health. 

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Health in the EU23 initiative, which includes the Health at a Glance: Europe series and the EU 
Country Health Profiles. By providing a comprehensive assessment of cardiovascular health 
across  the  EU,  the  report  aims  to  inform  future EU  and  national  policy  efforts.  Leveraging 
digital  health  technologies,  promoting  people-centred  care,  and  aligning  policies  and  cross-
sectoral actions can enhance progress, reduce inequalities, with a specific focus on women, and 
make cardiovascular care more efficient. 

Challenges across the EU 

Tackling  cardiovascular  diseases  and  their  main  risk  factors,  involves  several  significant 
challenges.  

Insufficient  focus  on  prevention:  nearly  80%  of  cardiovascular  diseases  can  be  prevented 
through  lifestyle  changes24.  However,  in  the  EU,  prevention  receives  only  3%  of  total 
healthcare spending despite being the most cost-effective investment in an overall context of 
increasingly challenging budgetary outlooks. The scale of the problem is clear. 

-  Between 2012 and 2022, diabetes prevalence rose by 22% and has doubled since 1990 
to  reach 7.8% of the population.  Hypertension affects almost  25% of  adults, and its 
prevalence is rising.  

-  Obesity is widespread, with 15% of adults and  9% of children living with obesity25. 
75% of obesity-related excess  deaths  are attributable to  cardiovascular diseases26.  In 
addition,  over  half  of  adults  are  overweight  in  the  EU  and  overweight  rates  among 
adolescents have increased to 21% in 2022, up from 17% in 201427.  

-  Almost a third of cardiovascular-related morbidity and mortality in Europe is due to 
uncontrolled  cholesterol28  with  the  prevalence  of  elevated/uncontrolled  cholesterol 
levels  over  50%  in  Europe29.  In  addition,  inherited  risk  factors  such  as  elevated 
lipoprotein-a,  familial  hypercholesterolemia  or  cardiomyopathy  also  contribute  to 
cardiovascular  disease  burden.  In  addition,  evidence  shows  that  sleep  disorders  also 
represent cardiovascular risk factors30. 

ESC 

clinical 

consensus 

statement. 

23 State of Health in the EU - Public Health - European Commission. 
24 World Heart Federation –  nearly 80% of deaths from cardiovascular diseases are due to modifiable risk factors 
(e.g. an unhealthy diet and a sedentary lifestyle). 
25 OECD report (2025) ‘The state of cardiovascular health in the EU’ - Full Report: The State of Cardiovascular 
Health in the European Union | OECD.  
26 Koskinas, K. C., Van Craenenbroeck, E. M., Antoniades, C., et al. (2024). Obesity and cardiovascular disease: 
An 
4063–4098. 
https://doi.org/10.1093/eurheartj/ehae508.  
27  https://cancer-inequalities.jrc.ec.europa.eu/sites/default/files/docs/ccp2025/ec-oecd-synthesis-report-250124-
1422.pdf.  
28 Gill, J., Miracolo, A., Politopoulou, K., Jayawardana, S., Carter, A., Apostolou, E., & Kanavos, P. (2024). How 
can  we  improve  secondary  prevention  of  cardiovascular  disease?  London  School  of  Economics  and  Political 
Science.  
29 Timmis, A., Vardas, P., Townsend, N., Torbica, A., Katus, H., De Smedt, D., et al. (2022). 
European Society of Cardiology:  Cardiovascular disease statistics 2021. European Heart Journal, 43(8), 716–
799. https://doi.org/10.1093/eurheartj/ehab892. 
30 Kwon, Y., Tzeng, W.S., Seo, J. et al (2024). Obstructive sleep apnea and hypertension; critical overview. Clin 
Hypertension 30 (1), 19. https://doi.org/10.1186/s40885-024-00276-7. 

European  Heart 

Journal, 

45(38), 

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-  Prevalence of lifestyle risk factors shows mixed progress31. Tobacco use has declined 
in  the  last  decade,  but  the  45%  increase  in  vaping  raises  concerns  about  emerging 
nicotine  habits.  Over  25%  of  the  population  has  an  insufficient  level  of  physical 
activity,  and  only  about  60%  of  adults  consume  fresh  fruit  and  vegetables  daily32. 
Alcohol consumption has slightly decreased33, however harmful use of alcohol remains 
a key risk factor for cardiovascular diseases and other NCDs, especially among young 
people34;  

-  Vaccination coverage among risk groups in many Member States remains suboptimal 
for vaccines that can reduce cardiovascular complications (e.g. influenza35 and COVID-
1936 vaccines); 

-  Environmental factors, such as pollution, account for 18% of cardiovascular deaths in 

the EU37.  

Tackling cardiovascular diseases requires efforts across all age groups. However, specific 
challenges and trends among children and adolescents are of particular concern:  

- 

type 1 diabetes typically starts early in life and at the same time type 2 diabetes is also 
increasingly  affecting  children  and  young  people  due  to  rising  obesity  rates  and 
unhealthy lifestyle factors; 

-  vaping  among  young  people  is  a  particular  concern,  raising  alarms  about  emerging 

- 

nicotine habits;  
increased  screen  time  and  lack  of  physical  activity  are  affecting  young  people’s 
health38; 

-  20% of young people are overweight or obese39; 
- 

sugar  consumption  in  children  and  young  people  is  higher  than  the  recommended 
levels, in particular, through sugar-sweetened beverages40; 

-  only 12% of adolescents achieve the recommended minimum intake of five portions of 
fruit  and  vegetables  daily,  whereas  42%  consume  no  portions  of  fruit  or  vegetables 
daily41; 

31 OECD report (2025) ‘The state of cardiovascular health in the EU’ - Full Report: The State of Cardiovascular 
Health in the European Union | OECD. 
32 [ilc_hch11] Persons eating fruit, vegetables or salad by educational attainment level, risk of poverty threshold, 
most frequent activity status and sex. 
33  Average alcohol consumption declined slightly by 3% between 2010 and 2022. 
34  Key  findings  from  the  2024  European  School  Survey  Project  on  Alcohol  and  Other  Drugs  (ESPAD): 
www.euda.europa.eu. 
35  European  Centre  for  Disease  Prevention  and  Control  (2024).  Survey  report  on  national  seasonal  influenza 
vaccination recommendations and coverage rates in EU/EEA countries.  
36 European Centre for Disease Prevention and Control. COVID-19 vaccination coverage in the EU/EEA during 
the 2024–25 season campaigns, 1 August 2024 – 28 March 2025. 
37 European Environment Agency (2025): Preventing cardiovascular disease through a healthy environment. 
38 Combinations of physical activity, sedentary time, and sleep duration and their associations with depressive 
symptoms and other mental health problems in children and adolescents: a systematic review - PubMed. 
39  Eurostat,  EU-SILC,  Person  distribution  by  body  mass  index,  educational  attainment  level,  sex  and  age: 
ilc_hch10. 
40 Azaïs-Braesco, V., Sluik, D., Maillot, M., Kok, F. and Moreno, L.A. (2017). A review of total & added sugar 
intakes and dietary sources in Europe, Nutrition Journal, 16 (1), 6. https://doi.org/10.1186/s12937-016-0225-2; 
Sugars and Sweeteners | Knowledge for policy.  
41  Eurostat  database:  [hlth_ehis_fv3e]  Daily  consumption  of  fruit  and  vegetables  by  sex,  age  and  educational 
attainment level. 

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- 

- 

the harmful  use of  alcohol including  binge drinking, is  a significant  concern  among 
young  people42.  Alcoholic  beverages,  such  as  ‘alcopops’43,  seem  to  be  particularly 
appealing to young people;  
anxiety and mental health issues amongst adolescents can contribute to poor lifestyle 
choices and cardiovascular risk44. 

Limited  access  to  early  detection  and  diagnosis:  early  detection  is  essential  because  risk 
factors  (e.g.  high  blood  pressure,  high  cholesterol  and  diabetes45)  can  go  unnoticed,  thus 
increasing the risk of a heart attack or stroke.  

-  Despite the accessibility of blood pressure checks, 14.3% of citizens aged 65 and older, 
reported not having had a recent measurement46, even though hypertension is a key risk 
factor for cardiovascular diseases. 

-  Structural  heart disorders  remain underdiagnosed, leaving  patients  at  risk of sudden, 

severe events. 

-  There  is  no  protocol  or  guidance  at  EU  level  which  would  help  Member  States  to 
develop early detection and diagnosis programmes, and this has resulted in fragmented 
approaches across the EU, which hinders data federation and collection of comparable 
data.  

-  Women are more likely to be misdiagnosed and to face delays in emergency care and 
under-treatment, especially after cardiovascular events, partly due to limited awareness 
among patients and healthcare workers. 

Treatment  and  care:  patients  with  cardiovascular  diseases  often  require  long-term 
management  and  a  multi-faceted  approach  involving  challenges  that  can  impact  patient 
outcomes.  

-  The  suboptimal  use  of  cardiovascular  medications  (e.g.  antihypertensives,  lipid 
lowering agents and anticoagulants) is an important gap in care across the EU, and there 
is a wide range of different clinical guidelines, and an overall EU approach is lacking.   

-  Continuity of care is lacking. Many patients face fragmented care pathways and unequal 
access to treatment. Patients often struggle to navigate between primary care, hospitals, 
and  rehabilitation  services,  thus  undermining  long-term  disease  management  and 
recovery. 

-  The lack of common standards for treatment and care across Member States leads to 
inequalities and inefficiencies, because innovative treatments and technologies are not 
equally accessible across the EU.  

42 Key findings from the 2024 European School Survey Project on Alcohol and Other Drugs (ESPAD). 
43 Alcopops are premixed alcoholic drinks that are designed to mimic the taste of a soft drink but contain added 
alcohol. 
44 UNICEF Report: The State of Children in the European Union: Addressing the needs and rights of the EU’s 
youngest generation. (2024). 
45 Marx, N., Federici, M., Schütt, K., Müller-Wieland, D., et al. (2023). 2023 ESC Guidelines for the management 
of  cardiovascular  disease  in  patients  with  diabetes:  Developed  by  the  task  force  on  the  management  of 
cardiovascular disease in patients with diabetes of the European Society of Cardiology (ESC), European Heart 
Journal. 44(39), 4043–4140, https://doi.org/10.1093/eurheartj/ehad192. 
46 Eurostat database: [hlth_ehis_pa2e] Self-reported screening of cardiovascular diseases and diabetes risks by 
sex, age and educational attainment level. 

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-  Multimorbidity  is  an  important  issue  among  cardiovascular  patients  and  is  strongly 
associated with poorer self-rated health and lower quality of life, sometimes even more 
than the presence of cardiovascular disease47.  

Digital and data challenges: without EU-level leadership on digital standards and investment, 
progress will remain fragmented, uneven and non-scalable.  

-  Only  six  Member  States  use  electronic  health  records  to  systematically  monitor 

cardiovascular outcomes48. 

-  Most  registries49  lack  interoperability,  making  it  difficult  to  share  or  compare  data 

across borders. 

-  Clinical data collection protocols and standards are insufficiently harmonised. 

-  Artificial intelligence (AI) and digital tools in cardiology exist, but few are deployed at 
scale  in  national  health  systems.  This  limits  opportunities  for  earlier  detection, 
personalised treatment, and system-wide improvements. When applying AI tools, it is 
key to ensure that gender, disability and other biases are avoided. 

Gaps in research and innovation: important challenges remain despite substantial investment 
in research and innovation.  

-  Knowledge  gaps  persist,  in  particular  in  the  understanding  of  disease  onset  and 

progression mechanisms. 

-  Gaps  exist  in  understanding  of  biological  mechanisms  underpinning  different  

cardiovascular diseases. 

-  Research translation should be fostered as innovations are slow to reach patients. 

- 

Important  gaps remain in  understanding  how to  apply  effective preventive measures 
consistently and how to support early intervention across diverse populations. 

-  Demand-driven innovation is not sufficiently supported.  

-  Cross-border collaboration, and AI innovation in cardiovascular diseases are hindered 
by  limited  availability  of  high-quality  data.  Sex-  and  gender-disaggregated  data  and 
data  on  other  protected  characteristics,  including  on  persons  with  disabilities,  is 
essential. 

Persistent health inequalities: There are striking differences and inequalities across Member 
States and regions, gender and socioeconomic groups.  

-  Conditions unique to women across the life course, including early and late menarche, 
polycystic  ovary  syndrome,  infertility,  assisted  reproductive  technology,  adverse 

47 Dunlay, S. M., & Chamberlain, A. M. (2016). Multimorbidity in Older Patients with Cardiovascular Disease. 
Current cardiovascular risk reports, 10, 3. https://doi.org/10.1007/s12170-016-0491-8; Skou, S. T., et al. (2022). 
Multimorbidity. Nature Reviews Disease Primers, 8(1), 48. https://doi.org/10.1038/s41572-022-00376-4.  
48 OECD report (2025) ‘The state of cardiovascular health in the EU’ - Full Report: The State of Cardiovascular 
Health in the European Union | OECD.  
49 Examples include European cardiovascular registries such as the ESC EURObservational Research Programme 
(EORP)  and  national  disease-specific  registries  listed  in  the  European  Directory  of  Registries.  Their 
heterogeneous data structures and standards limit interoperability across borders. 

6 

 
 
 
pregnancy  outcomes,  hormonal  contraceptives  and  transitions  to  menopause,  all  of 
which increase their risk for cardiovascular diseases50. 

-  Access to high-quality cardiac care varies significantly between Member States, leading 
to  differences  in  survival  rates  and  quality  of  life.  Mortality  from  cardiovascular 
diseases  is  significantly  higher  in  some  regions  than  in  others,  due  to  differences  in 
prevention, access to care, and health system resources51.  

-  Socio-economically  disadvantaged  population  groups  are  disproportionately  affected 
by risk factors like unhealthy diets, smoking, air52 and noise pollution53. They also often 
have limited access to prevention and treatment. This results in worse health outcomes, 
with more chronic conditions, that cause further inequalities in prevention, treatment, 
and management. 

2.  ACTION AT EU LEVEL ON CARDIOVASCULAR HEALTH: A TARGETED APPROACH 

The Safe Hearts Plan is a strategic response to the challenges described above. It focuses 
on delivering a selected number of ambitious and targeted actions that can deliver clear EU 
added value for citizens, governments, and stakeholders, in line with the EU’s competitiveness 
agenda and the rapid development of digital innovation. It is designed to improve people’s lives 
and public health at  societal  level,  boost competitiveness,  promote innovation  and invest in 
sustainable healthcare systems.  

Tackling cardiovascular  diseases requires  a  preventive,  cross-sectoral  and multi-stakeholder 
approach, in line with the One Health54 approach, which is based on the interconnection and 
interdependence between the health of humans,  animals,  plants and the  wider environment. 
The plan puts patients and citizens at its centre and aims to complement national policies and 
promote efficiency and competitiveness through collaborative research and innovation. 

The Safe Hearts Plan is built on three key pillars across the entire cardiovascular patient 
pathway:  (1)  prevention;  (2)  early  detection  and  screening;  and  (3)  treatment  and  care, 
including rehabilitation.  

These are supported by three cross-cutting themes:  

(1)  the  promising  opportunities  offered  by  digital  solutions,  including  AI  technologies  and 
personalised medicine approaches;  

50 Vogel, B. et al. (2021), The Lancet women and cardiovascular disease Commission: reducing the global burden 
by 2030. 
51 In 2022, regional mortality rates varied from 139 deaths per 100,000 people to 1196 deaths. Source: Eurostat 
https://ec.europa.eu/eurostat/web/products-datasets/-/hlth_cd_asdr2.    
52 Despite improving trends overall, inequalities remain with PM2.5 concentrations consistently higher by around 
one third in the poorest regions: https://www.eea.europa.eu/en/analysis/indicators/income-related-environmental-
inequalities-associated.   
53 Vulnerable and low-income communities can be disproportionately affected by noise pollution:   
https://www.eea.europa.eu/en/analysis/publications/environmental-noise-in-europe-2025.     
54 One Health - Public Health - European Commission. 

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(2) addressing the research and innovation gaps across the entire cardiovascular health pathway 
as a key driver for high  quality  knowledge, information  and  healthcare solutions  as  well as 
digital tools; and  

(3) reaching every citizen because inequalities exist between countries and regions, population 
groups and genders.  

Each pillar includes flagship initiatives and other actions, where EU-level action can bring 
added value, while also respecting national competences in health policy.   

With these initiatives the EU will aim to reach the following targets,55 by 2035:  

- 

- 

- 

cardiovascular  premature  mortality  to  decrease  by  25%  with  2022  as  the  baseline 
year56; 
at least 75% of people aged 25 to 64, and at least 90% of people aged 65 and older, 
have their blood pressure measured once a year by a health professional57; 
at least 65% of people aged 25 to 64, and at least 80% of people aged 65 and older, 
have their cholesterol measured once a year by a health professional58; 

-  at least 65% of people aged 25 to 64, and at least 80% of people aged 65 and older, 

have their blood sugar measured once a year by a health professional59.  

3.  PILLAR 1: PREVENTION - A LIFE COURSE AND PERSONALISED APPROACH 

Prevention  is  the  most  cost-effective  way  of  addressing  the  significant  burden  of 
cardiovascular diseases and the major risk factors, such as diabetes and obesity.  

Cardiovascular diseases are largely preventable through targeted action on key modifiable risk 
factors (e.g. diet, physical activity, tobacco and  harmful use of alcohol). Environmental and 
public health measures, such as reducing exposure to pollution and climatic stressors also play 
a crucial role in lowering cardiovascular risk especially in vulnerable populations.  

To translate the potential of prevention into tangible action, the Commission will launch a new 
flagship programme on a lifelong, personalised and digitally enabled cardiovascular disease 
prevention – the ‘EU cares for your heart’. The flagship initiative will support Member States 
in capacity-building to develop or strengthen national cardiovascular health plans, and it will 
support  Member  States  in  their  efforts  to  step  up  prevention,  including  using  personalised 
approaches and digital tools.  

55 The definitions of these targets will be considered in the early detection and screening protocol as well as the 
treatment  guidance.  These  targets  will  be  further  defined  in  the  design  of  the  early  detection  and  screening 
programmes 
56 In 2022, the most common cause of premature death is ischaemic heart disease with 77 704 deaths (17.9 per 
100 000 inhabitants): Source: Eurostat [hlth_cd_apr] Treatable and preventable mortality of residents by cause 
and sex. 
57 Eurostat online database, Self-reported screening of cardiovascular diseases and diabetes risks by sex, age and 
educational attainment level[hlth_ehis_pa2e__custom_19301842]. 
58 Eurostat online database, Self-reported screening of cardiovascular diseases and diabetes risks by sex, age and 
educational attainment level[hlth_ehis_pa2e__custom_19301918]. 
59 Eurostat online database, Self-reported screening of cardiovascular diseases and diabetes risks by sex, age and 
educational attainment level[hlth_ehis_pa2e__custom_19301947]. 

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13 Member States already have national cardiovascular health plans or strategies60, and this 
flagship  programme  will  support  all  27  Member  States61  in  developing  and  implementing 
policies to reduce the cardiovascular disease burden. Updated estimates on national spending 
on  preventive  cardiovascular  health  will,  through  an  EU-funded  OECD  project62,  allow  the 
Member States to benchmark their investments, identify gaps and receive strategic guidance 
on how to allocate resources more efficiently.  

The  flagship  programme  will  invest  in  supporting  Member  States  in  improving  prevention, 
early  detection  and  care.  It  will  use  digital  tools  and  personalised  medicine  approaches, 
especially for vulnerable groups. It will aim to empower patients and healthcare professionals 
with  digital  tools  for  improved  prevention  and  will  invest  in  stakeholder-led  targeted 
prevention and early detection actions63 that include a focus on vulnerable groups. 

Some Member States64 have developed their own integrated national or regional digital health 
platforms.  These  Member  States  now  have  the  capacity  to  implement  data-driven  and  AI-
enabled systems as part of routine health service delivery. Their experience demonstrates what 
is already possible, from predictive analytics and diagnostic automation to system optimisation 
and personalised care pathways. Building on the experience of these Member States, targeted 
EU investment could support the scaling-up of interoperable, data-driven and AI-enabled care 
solutions across the EU. Several EU co-funded projects, such as JADECARE65, have laid the 
foundations  for  digitally  assisted  care  models.  The  Commission  intends  to  mobilise  the 
communities developed within these projects, scale up their best practices, and extend their 
innovations across the EU. Now is the time to put these achievements into practice, linking the 
EU’s digital assets, promoting interoperability, and accelerating the deployment of AI-enabled 
solutions that make health systems more resilient, equitable and efficient. 

Flagship initiative: a lifelong, personalised and digitally enabled prevention – the ‘EU 
cares for your heart’ programme  

The Safe Hearts Plan encourages Member States to develop or implement  standalone or 
integrated  national  cardiovascular  health  plans  by  2027,  taking  into  account  existing 
initiatives, and will propose actions to help Member States to do so.  

The  Commission  intends  to  co-create  this  flagship  programme  together  with  Member 
States, stakeholders, such as hospitals, the public health community, industry, academia and 
citizens, particularly young people, to ensure that it supports national health systems and 
puts citizens at its core for better future health.  

60  Croatia,  Czechia,  Estonia,  Finland,  France,  Latvia,  Luxembourg,  Netherlands,  Poland,  Portugal,  Romania, 
Spain and Sweden have national cardiovascular disease control plans. 
61 EU4Health 2025 work programme. 
62 This is an EU - OECD partnership: 26284fbb-0c7b-4d4d-ae57-f7f2a47e493f_en. 
63 European Commission,  Call for proposals on lifelong prevention for a healthy life with focus on cardiovascular 
diseases, CR/CV&NCD-g-25-18,  26284fbb-0c7b-4d4d-ae57-f7f2a47e493f_en. 
64 Such as Finland, Denmark and Estonia. 
65 JADECARE, Joint Action on implementation of digitally enabled integrated person-centred care. 

9 

 
 
 
 
Healthy  dietary  habits  (e.g.  daily  fruit  and  vegetable  intake,  and  consuming  less  sugar, 
saturated  fats  and  salt  when  they  have  a  negative  impact  on  health  and  when  consumed 
disproportionately within a daily or weekly diet), reduce the risk of cardiovascular diseases. 
Emerging  research66  also  highlights  the  role  of  diet  in  shaping  the  gut  microbiome,  thus 
opening  new  avenues  for  personalised  medicine  to  address  risk  factors.  Dietary  habits  also 
influence oral health which is in turn vital element of cardiovascular health67.  

The  Commission  supports  actions  to  improve  dietary  habits,  including  through  the  food 
industry-led EU Code of Conduct on Responsible Food Business and Marketing Practices68 
(also called the Agri-food Code), as well as Food 203069, the research and innovation policy 
framework  deployed  under  the  Horizon  Europe  programme.  In  addition,  the  Commission 
supports national reformulation initiatives to reduce the levels of saturated fats, sugar and salt 
in the context of the overall daily or weekly diet and promotes the consumption of fruit and 
vegetables. The Commission has completed a review of the successful EU school scheme on 
fruits, vegetables and milk and milk products, and proposed its continuation beyond 202770. 
Local governments could be supported and motivated to ensure that healthy foods are served 
in public institutions such as schools, hospitals, and government facilities. A recently published 
report by the Joint Research Centre on criteria for sustainable public procurement for food, 
catering  services  and  vending  machines  can  be  used  by  local  governments  to  ensure  that 
healthy foods are served in public institutions71.  

The increase in NCDs linked to unhealthy diets and so-called ‘ultra-processed foods’, makes it 
necessary to provide clear information to empower citizens to be aware of the nutrition choices 
at their disposal, and preferably choose healthier food options. Evidence-based information on 
food  can  also  serve  as  a  basis  for  EU  or  national  level  interventions  addressing  unhealthy 
foodstuffs and incentivising food reformulation. 

The Commission has launched a study72 on the impact of the consumption of so-called ‘ultra-
processed foods’, based on the opinions of the Scientific Advisory Mechanism (SAM) and of 
the European Group of Ethics (EGE). These opinions will support the annual food dialogue 
created under the Vision for Food and Agriculture73.  

66 Ahmad, A. F., Dwivedi, G., O'Gara, F., Caparros-Martin, J., & Ward, N. C. (2019). The gut microbiome and 
cardiovascular  disease:  Current  knowledge  and  clinical  potential.  American  Journal  of  Physiology-Heart  and 
Circulatory Physiology, 317(5), H923–H938. https://doi.org/10.1152/ajpheart.00376.2019.  
67  Hopkins  S,  Gajagowni  S,  Qadeer Y,  Wang  Z,  Virani  SS,  Meurman  JH,  Leischik  R,  Lavie  CJ,  Strauss  M, 
Krittanawong  C.  More  than  just  teeth:  How  oral  health  can  affect  the  heart.  Am  Heart  J  Plus.  2024  May 
24;43:100407. doi: 10.1016/j.ahjo.2024.100407. PMID: 38873102; PMCID: PMC11169959. 
68 Code of Conduct - Food Safety - European Commission. 
69 Food 2030 - Research and innovation - European Commission. 
70 School scheme explained - European Commission. 
71  Criteria  for  Sustainable  Public  Procurement    for  Food,  Food  Services  and Vending  Machines  (2025),  Joint 
Research Centre - https://publications.jrc.ec.europa.eu/repository/handle/JRC139495. 
72  As foreseen in the Communication from the Commission to the European Parliament, the Council, the European 
Economic and Social Committee and the Committee of the Regions,  A Vision for Agriculture and Food Shaping 
together an attractive farming and agri-food sector for future generations, COM(2025) 75 final. 
73 Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social  Committee and the  Committee of the Regions, A Vision for Agriculture and Food  Shaping together an 
attractive farming and agri-food sector for future generations, COM(2025) 75 final.  

10 

 
 
 
Flagship initiative: empowering consumers through information on food processing 
in the EU  

The  Commission  will  work  towards  a  new  comprehensive  food  processing  assessment 
system,  looking  into  portions,  frequency  of  intake  and  role  in  the  diet,  to  empower 
consumers  with  transparent,  accessible,  science-based  digital  information  on  food 
processing, with the aim to ultimately encourage shifts towards healthier diets. 

Smoking is a major cause of cardiovascular diseases as well as other NCDs. Active smoking 
and second-hand smoke exposure cause around 20% of coronary heart diseases.  Significant 
progress has already been made, but smoking rates in the EU remain high, particularly among 
young people. In 202274, more than one in six 15-year-olds that were surveyed stated that they 
had smoked cigarettes at least once during the preceding month.  

The  EU’s  legislative  framework  on  tobacco  control75  has  successfully  contributed  to  the 
significant decline in smoking rates, including among young people76. However, novel tobacco 
and nicotine products, such as heated tobacco products, e-cigarettes and nicotine pouches, have 
become  increasingly  popular  in  recent  years,  especially  among  young  people.  Emerging 
evidence highlights the health risks associated with these products and suggests that they may 
serve as a gateway to nicotine addiction and traditional tobacco consumption. With a view to 
protecting young people in particular from the harmful effects of tobacco and related products, 
the  Commission  is  considering  these  new  developments  and  market  trends  in  its  on-going 
evaluation of the legislative framework on tobacco control.  

Taxation at EU level has played a pivotal role in reducing risk factors linked to our lifestyles. 
Around  40%  of  the  decline  in  smoking  in  the  EU  in  the  past  decade  can  be  attributed  to 
taxation77. According to the World Health Organization (WHO), taxation is one of the most 
effective  instruments  in  curbing  tobacco  consumption78.  On  16  July  2025,  the  Commission 
adopted a proposal for an amendment of the Tobacco Taxation Directive79 to raise excise duty 
rates on traditional tobacco products and to harmonise taxation on novel tobacco and nicotine 
products, such as e-cigarettes, heated tobacco products, nicotine pouches and other nicotine 
products. In the light of evolving public health challenges and significant shifts in the market, 
the reform aims to modernise the directive in line with the EU’s health and economic priorities 
and to strengthen the single market. The revision of the directive will make a key contribution 
to  achieving  the  objective  of  Europe’s  Beating  Cancer  Plan  for  a  tobacco-free  generation, 
where less than 5% of the population uses tobacco by 2040. 

74 The Eurobarometer survey on Attitudes of Europeans towards tobacco and related products. 
75 Directive 2014/40/EU of the European Parliament and of the Council of 3 April 2014 on the approximation of 
the  laws,  regulations  and  administrative  provisions  of  the  Member  States  concerning  the  manufacture, 
presentation and sale of tobacco and related products and repealing Directive 2001/37/EC, OJ L 127, 29.4.2014, 
pp.  1–38;  Directive  2003/33/EC  of  the  European  Parliament  and  of  the  Council  of  26  May  2003  on  the 
approximation  of  the  laws,  regulations  and  administrative  provisions  of  the  Member  States  relating  to  the 
advertising and sponsorship of tobacco products, OJ L 152, 20.6.2003, pp. 16–19.  
76 The Eurobarometer survey on Attitudes of Europeans towards tobacco and related products. 
77 Impact analysis of the review of tobacco excise duty rules - Publications Office of the EU. 
78 Health Promotion – WHO, tobacco taxation. 
79 Council Directive 2011/64/EU of 21 June 2011 on the structure and rates of excise duty applied to manufactured 
tobacco, OJ L 176, pp. 24–36. 

11 

 
 
 
Flagship initiative: modernising tobacco control legislation  

The  Commission  intends  to  propose,  in  2026,  a  revision  of  the  legislative  framework  on 
tobacco control.   

The long-term goal is for fewer than 5% of adults to be using tobacco by 204080.  

Harmful use of alcohol is a risk factor for cardiovascular diseases Alcohol consumption levels 
and patterns vary considerably across the EU.  

The  harmful  use  of  alcohol,  including  underage  and  binge  drinking  from  an  early  age  is  a 
significant  concern81.  Alcoholic  beverages,  such  as  ‘alcopops’82,  seem  to  be  particularly 
appealing  to  young  people.  This  calls  for  targeted  approaches,  focusing  on  harmful 
consumption, particularly regarding underage and binge drinking83. 

Levies, taxes and duties can serve as incentives to influence consumer behaviour, encouraging 
healthier food choices, including by limiting the consumption of sugar-sweetened beverages 
and alcoholic beverages84. Since 2015, 13 Member States have introduced taxes on unhealthy 
food products, the majority on sugar-sweetened beverages and some on foods high in fat, sugar 
and salt85. The Commission will continue to support Member States in advancing taxation by 
discussing the design and practical implementation of such measures applied to non-alcoholic 
beverages with Member States.  

Sustainable support to prevention at EU level: according to the 2025 Eurobarometer survey, 
citizens believe that public health is one of the top five most important areas that the EU should 
prioritise86.  In  2022,  preventive  services  accounted  for  5.5%  of  the  EU’s  total  healthcare 
expenditure. The largest share went to curative and rehabilitative care (51.9%), followed by 
medical  goods  like  pharmaceuticals  (17.8%)  and  long-term  care  (16.2%).  Spending  on 
prevention does not reach 5% in the case of most of the national healthcare budgets87. In this 
context it is suggested to support Member States’ efforts in primary prevention.  

There is evidence linking a high intake of so-called ‘ultra-processed foods’ with high sugar, fat 
and salt content with the risk of developing obesity, diabetes and a range of metabolic diseases, 
which are risk factors for cardiovascular diseases88. Such diseases are thus having a serious 
impact  not  only  on  EU  citizens  but  also  on  health  systems  and  the  EU’s  overall 
competitiveness. In this respect, an initiative on so-called ‘ultra-processed food’ related to these 
morbidities should be considered.  

80 Communication from the Commission to the European Parliament and the Council, Europe’s Beating Cancer 
Plan, COM(2021) 44 final. 
81  Key  findings  from  the  2024  European  School  Survey  Project  on  Alcohol  and  Other  Drugs  (ESPAD):  
www.euda.europa.eu. 
82 Pre-mixed alcoholic drink designed to mimic the taste of a soft drink but with added alcohol. 
83 Health Promotion and Disease Prevention Knowledge Gateway: https://knowledge4policy.ec.europa.eu/health-
promotion-knowledge-gateway/alcoholic-beverages_en. 
84 Study on Health Taxes from an EU Perspective - Taxation and Customs Union. 
85 Denmark taxes ice-cream and confectionary and Hungary taxes food products containing high levels of salt, in 
addition to sugar sweetened beverages.  
86 https://europa.eu/eurobarometer/surveys/detail/3380. 
87 https://data.europa.eu/en/publications/datastories/health-and-well-being-eu-investing-where-it-matters. 
88 Ultra-Processed Foods and Human Health, The Lancet series.  

12 

 
 
 
The Commission intends to: 

➢  establish a network of competent authorities to  provide a forum  for cooperation and 
coordination  in  the  taxation  of  unhealthy  food  products  to  support  the  exchange  of 
information and best practices among Member States;   

➢  set up a database of such taxes or levies in force in Member States. 

Flagship initiative: based on the outcome of the study on so-called ‘ultra-processed foods’, 
the  Commission  will  examine  which  appropriate  tools,  including  possible  financial 
actions,  could  be  deployed  to  support/fund  public  health  actions  in  the  field  of  primary 
prevention and stimulate food reformulation and healthier consumer choices. 

Sports and regular physical activity offer significant benefits for cardiovascular health by 
strengthening  the  heart  muscle,  improving  blood  circulation,  and  helping  to  regulate  blood 
pressure  and  cholesterol  levels.  Promoting  regular  physical  activity  remains  essential  for 
healthier communities, disease prevention and overall well-being across the EU. 

The Commission intends to:  

➢  propose  an  update  of  the  Council  Recommendation  on  promoting  health-enhancing 

physical activity across sectors;  

➢  strengthen awareness of the link between regular physical activity and cardiovascular 
health through annual Europe-wide campaigns, including the #BeActive campaign and 
the European Week of Sport89; 

➢  continue to provide EU funding to support physical activity, including its crucial role 

in prevention, through programmes such as Erasmus+90 and EU4Health.  

Focus on children and young people  

Prevention of cardiovascular diseases, diabetes and obesity must start in childhood. Preventing 
obesity  in  children,  in  particular,  is  key  to  reducing  the  risk  of  diabetes  and  cardiovascular 
diseases in early adulthood.  

Early intervention with children and young people creates a unique opportunity to establish 
lifelong healthy habits, including healthy diets and physical activity91. The Commission will 
continue  to  promote  the  consumption  of  fruit  and  vegetables.  The  findings  from  the  WHO 
study92 on children’s eating habits highlight that action is needed to promote healthy eating 
habits among children, to increase daily consumption of fresh fruit and vegetables. Excessive 
consumption of foods and beverages that are high in sugar is linked to an increased risk for 
obesity. Schools and other educational settings can significantly influence children’s and young 
people’s eating habits through education and the provision of healthy food choices to encourage 
the intake of healthier foods, such as fruit and vegetables.  

89 Starting in June 2026, these initiatives will aim to engage millions of Europeans across more than 50,000 events 
each year, encouraging healthier lifestyles and reducing cardiovascular risk. 
90 Home - Erasmus+. 
91 Study on the evaluation of the EU Action Plan on Childhood Obesity. 
92 How healthy are children’s eating habits? – WHO/Europe surveillance results. 

13 

 
 
 
The Commission is funding collaborative actions between Member States and stakeholder-led 
projects that promote healthy eating and physical activity through education, and policy and 
community  engagement93.  In  addition,  research  projects94,  are  focusing  on  identifying  risk 
factors, e.g. obesity and on improving healthy diets95, promoting prevention, and developing 
personalised interventions to  support lifelong  healthy lifestyles specifically for children and 
young people. Sports and regular physical activity offer significant benefits for cardiovascular 
health by strengthening the heart muscle, improving blood circulation, and helping to regulate 
blood pressure and cholesterol levels. However, fewer than 1 in 5 boys and 1 in 10 girls (5-17 
years) meet the WHO’s recommended level of physical activity96.  

The rapid  growth  in  the  consumption and sales of novel  tobacco  and nicotine products e.g. 
heated tobacco products, e-cigarettes, and nicotine pouches, among young people is alarming. 
Around one in five of young people (15-19 years) that consume tobacco and nicotine products 
started  out  by  regularly  using  e-cigarettes97.  This  clearly  indicates  that  e-cigarettes  act  as  a 
gateway to nicotine addiction and tobacco use among young people.  

Children  and  young  people  are  particularly  vulnerable  to  marketing  on  so-called  ‘ultra-
processed’  foods  and  foods  high  in  fat,  sugar,  and  salt,  as  well  as  tobacco  and  emerging 
products.  The  Audiovisual  Media  Services  Directive98  aims  to  protect  viewers,  including 
children  from  harmful  advertising.  It  encourages  co-regulation  and  self-regulation  to  limit 
children’s exposure to marketing of unhealthy foods and beverages.  

The Commission intends to:  

➢  evaluate  the  Audiovisual  Media  Service  Directive  which  includes  rules  to  protect 
minors  from  harmful  content,  by  the  end  of  2026,  and  consider  a  proposal  for  its 
revision;  

➢  present a ‘Toolkit for Child and Adolescent Health and Mental Wellbeing Promotion’ 
by  the  end  of  2026,  to  support  policymakers  in  improving  the  physical  and  mental 
health of children99. 

Climate  change  and  environmental  factors,  such  as  air  or  noise  pollution  significantly 
impact cardiovascular diseases, especially among vulnerable groups. Fossil fuel combustion 
and  extreme  weather  events  may  cause  or  worsen  cardiovascular  diseases.  Climate-related 
cardiovascular  risks  are  already  recognised  in  20  out  of  27  national  adaptation  policies100. 
Switching to a clean energy economy, reducing pollution and integrating health into climate 
adaptation  plans,  especially  at  local  level,  are  essential  to  ensure  appropriate  responses  and 
lower cardiovascular disease rates.   

Vaccination  against  infections,  e.g.  influenza,  SARS-CoV-2  (COVID-19),  respiratory 
syncytial virus, pneumococcal disease and or herpes zoster, is an effective measure to prevent 

93 Funded under the EU4Health programme: Health4EUKids; Schools4Health; DUSE; RYHEALTH. 
94 BIO-STREAMS; OBELISK; PAS GRAS; HealthyW8 (EUR 40 million from Horizon Europe); The PREVENT 
Living Labs: A new approach to tackling childhood obesity - PREVENT. 
95 Zero Hidden Hunger EU; PLAN’EAT;  Co Diet (EUR 27 million from Horizon 2020 programme). 
96 Step Up! Tackling the Burden of Insufficient Physical Activity in Europe | OECD. 
97 Attitudes of Europeans towards tobacco and related products - June 2024 - Eurobarometer survey. 
98 Audiovisual Media Services Directive. 
99 The European Commission and UNICEF announce a new partnership to improve health outcomes for children. 
100 European Climate and Health Observatory.  

14 

 
 
 
cardiovascular  complications  in  high-risk  groups101.  Vaccinating  for  all  these  diseases  for 
people aged 65 and over, as well as those with cardiovascular diseases, reduces the risk of heart 
attacks, stroke and other acute events. Influenza vaccination is associated with a 34% reduction 
in  the  risk  of  major  adverse  cardiovascular  events102,  highlighting  immunisation  as  an 
important preventive strategy103.  

The Commission supports national efforts to increase vaccination coverage through EU-funded 
projects104,  the  European  Vaccination  Information  Portal105  and  campaigns  like  #United  in 
Protection106. The Commission collaborates with the European Centre for Disease Prevention 
(ECDC)  and  the  European  Medicines  Agency  (EMA)  to  counter  disinformation,  support 
national  vaccination  strategies  with  scientific  evidence,  monitor  the  performance  of 
immunisation programmes ensure transparency in vaccine approval, and maintain independent 
post-authorisation surveillance.  

The ECDC would help Member States by:  

➢  providing  guidance  and  capacity-building  to  strengthen  national  immunisation 
information  systems  and  registries  for  cardiovascular  disease-risk  groups,  including 
interoperability  standards  and  reporting  indicators,  in  accordance  with  the  legal 
framework of the European Health Data Space (EHDS);  

➢  providing targeted training to healthcare professionals on the link between key vaccine-

preventable diseases and cardiovascular diseases. 

Flagship  initiative:  proposal  for  a  Council  recommendation  on  vaccination  against 
respiratory infections as a preventive measure for cardiovascular diseases  
The Commission intends to propose a Council recommendation to promote immunisation107 
as  a  measure  to  prevent  cardiovascular  diseases,  taking  a  lifelong  approach  and  tackling 
high-risk  vulnerable  groups.  Member  States  are  envisaged  to  be  offered  support  in 
identifying  the  target  population  for  vaccination,  and  in  monitoring  and  increasing  their 
vaccination coverage. 

The proposal for a Council recommendation would aim to encourage all Member States to 
report vaccination coverage data for influenza and COVID-19 respiratory syncytial virus and 

101 Heidecker, B., Libby, P., Vassiliou, V. S., Roubille, F., Vardeny, O., Hassager, C., et al. (2025). Vaccination as 
a new form of cardiovascular prevention: A European Society of Cardiology clinical consensus statement: With 
the  contribution  of  the  European  Association  of  Preventive  Cardiology  (EAPC),  the  Association  for  Acute 
CardioVascular Care (ACVC), and the Heart Failure Association (HFA) of the  ESC. European Heart Journal, 
46(36), 3518–3531. https://doi.org/10.1093/eurheartj/ehaf384. 
102 Behrouzi, B., Bhatt, D. L., Cannon, C. P., et al. (2022). Association of influenza vaccination with cardiovascular 
risk: A meta-analysis. JAMA Network Open, 5(4), e228873. https://doi.org/10.1001/jamanetworkopen.2022.8873   
103 A recent clinical consensus document from the European Society of Cardiology highlights the importance of 
immunisation as a preventive strategy that improves survival, reduces hospitalisations, and enhances quality of 
life. 
104 European Immunisation Week 2025: EU4Health and Horizon Europe projects protecting the health of people 
of all ages - European Commission. 
105 European Vaccination Information Portal. 
106 European Commission actions on vaccination. 
107 New systematic review and meta-analysis shows an association between shingles vaccination and lower risk 
of heart attack and stroke. 

15 

 
 
 
pneumococcal disease, and viral infections such as herpes zoster, in individuals with chronic 
conditions, including cardiovascular diseases, by 2029. 

Health  literacy108  is  crucial  to  empower  citizens  to  make  informed  decisions  about  their 
lifestyle and habits, to engage in personalised prevention and early detection to manage risk 
factors  like  high  blood  pressure  and  to  seek  timely  help.  The  Commission  is  working  with 
Member States on strengthening health literacy, e.g. through the development of new tools to 
inform citizens on healthy lifestyles, and the creation of a European health literacy arena109. 
Through e-Twinning, the Commission also promotes teacher training and collaborative school 
projects on health literacy that deal with health, wellbeing, digital health, inclusion, healthy 
habits and mental health education. 

To further support these efforts: 

➢  the  EU-funded  European  Code  against  Cancer110  will  be  updated  with 
recommendations for the prevention of cancer and other non-communicable diseases 
such as cardiovascular diseases that share common risk factors.  

4.  PILLAR 2: EARLY DETECTION AND SCREENING OF THOSE AT RISK 

Early  detection  and  screening  are  important  public  health  tools  in  disease  prevention,  in 
particular for cardiovascular diseases, given their scale, cost and largely  preventable nature. 
Investing in early detection and screening programmes through health checks can enable the 
timely  identification  of  individuals  at  high  risk  (e.g.  those  with  high  blood  pressure,  high 
cholesterol  or  obesity),  before  symptoms  emerge.  Personalised  medicine  approaches  are 
critical to enable early detection and diagnosis, through the identification of patients at risk111.  

In addition to traditional screening areas, detection of kidney disease, and congenital conditions 
such  as  elevated  lipoprotein(a)  (which  affects  every  fifth  person),  the  presence  of  familial 
hypercholesterolemia,  cardiomyopathies  as  well  as  early  detection  of  heart  failure  risk,  or 
detection of obstructive sleep apnoea, should also be included in the scope of the screening.  

It is essential for citizens to know the key cardiovascular risk factors e.g. high blood pressure, 
cholesterol, blood sugar and body weight, genetic predisposition as this data provides a clear 
picture  of  the  heart-health  risk.  People  who  understand  their  own  risk  profile  are  better 
equipped to make lifestyle changes and engage proactively with the health system, leading to 
earlier detection, effective management, and significantly lower likelihood of cardiovascular 
events. Early detection can prevent disease progression, reduce hospital admissions and avoid 
costly  emergency  care.  Screening  initiatives  should  be  adapted  to  national  and  regional 
situations and should include large-scale screening of a defined population group based on age, 
sex, gender and other protected characteristics112 or geographical  area. They should  also be 
targeted at specific subgroups of the population that are at a higher risk because of their family 
history, medical history or lifestyle or environmental factors.  

108  The  ability  to  understand,  access  and  use  health  information  which  is  essential  in  the  prevention  of 
cardiovascular diseases. 
109 Strengthening health literacy to reduce inequalities in cancer and other NCDs. JA PreventNCD. 
110 ECAC5 project - Revision and update of the European Code against Cancer. 
111 POCCardio project, funded by Horizon Europe (EUR 14 million).  
112 Non-discrimination - European Commission. 

16 

 
 
 
Risk  prediction  tools113  are  used  to  estimate  a  person’s  risk  of  developing  cardiovascular 
disease.  They  typically  include  indicators  (e.g.  blood  sugar  and  lipid  levels,  blood  pressure 
measurements and body mass index) and assessment of lifestyle factors (e.g. smoking, physical 
activity and nutrition). However, blood pressure monitoring rates are still suboptimal across 
the  EU,  especially  among  older  people.  Regular  monitoring  through  health  checks  would 
enable early detection and timely management of high blood pressure, significantly reducing 
the  risk  of  heart  attacks,  strokes,  and  other  cardiovascular  complications,  while  supporting 
healthier ageing and improved quality of life.  

To  ensure  wide  coverage  of  the  screening  programme,  the  Commission is  ready  to  support 
Member  States  in  organising  community-based  screening  initiatives  that  bring  preventive 
health services directly to the population. Relevant stakeholders should be invited to participate 
and contribute their expertise. 

The current poor state of cardiovascular health is also attributable to other risk factors, such as 
genetic  conditions  including  familial  hypercholesterolemia  (FH)  or  elevated  levels  of 
lipoprotein(a),  which  can  now  be  easily  screened.  These  inherited  conditions  remain 
significantly underdiagnosed across the EU. FH affects around 1 in 250 individuals, but fewer 
than 10% of cases are detected and diagnosis is often delayed until after a cardiovascular event 
has occurred. To strengthen cardiovascular disease prevention, particularly among children and 
young adults, ongoing EU-funded projects114 are supporting the development of strategies for 
earlier diagnosis and management of inherited conditions to improve outcomes for patients and 
their families.   

The Commission intends to:  

➢  work  closely  with  the  Member  States  to  support  the  introduction  of  early  detection 

initiatives or screening programmes for FH, depending on the population risk.  

In addition, Member States could make use of cohesion funds to enhance laboratory capacity, 
genetic  testing  services,  and  digital  registries.  Member  States  may  consider  incentives  to 
stimulate  participation  in  screening  programmes.  This  could  take  the  form  of  initiatives  to 
facilitate timely follow-up after screening, helping citizens to benefit from early detection while 
fully  respecting  Member  States’  responsibility  for  organising  and  managing  their  health 
systems. 

The integration of risk prediction tools empowers both individuals and healthcare providers to 
make informed decisions and apply personalised prevention plans. For example, polygenic risk 
scores115 have the potential to assess the personal risk of developing cardiovascular diseases 
with a genetic background. When combined with digital tools, AI and advanced computational 
models,  including  Virtual  Human  Twins116,  in  early  detection  efforts  could  further  reduce 
hospitalisations,  improve  health  outcomes,  and  generate  economic  benefits  by  shifting  the 

113 SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. 
European Heart Journal. 42 (25), 2439-2454. https://doi.org/10.1093/eurheartj/ehab309. 
114 FH-EARLY and BIOMARCARE; PERFECTO. 
115 Schunkert, H., Di Angelantonio, E., Inouye, M., Patel, R. S., et al. (2025). Clinical utility and implementation 
of polygenic risk scores for predicting cardiovascular disease, European Heart Journal, Oxford Academic. 46(15), 
1372-1383. https://doi.org/10.1093/eurheartj/ehae649. 
116 Virtual Human Twins initiative for health and care.  

17 

 
 
 
focus from treatment to prevention. This approach could save lives and generates long-term 
economic and societal benefits.  

Cardiovascular  diseases,  unlike  cancer,  lack  a  harmonised  protocol  for  early  detection  and 
diagnosis. This results in fragmented approaches across the EU, and that in turn hinders data 
federation and collection of comparable data. The Safe Hearts Plan includes the development 
of an EU protocol on health checks to improve timely detection and early diagnosis, reduce 
health inequalities and lower healthcare costs. The protocol would provide a framework for 
Member  States  to  implement  health  checks  to  support  the  early  detection  of  cardiovascular 
diseases, diabetes and obesity. By identifying individuals  at-risk and helping them to  better 
understand and manage  their health proactively,  the protocol  would facilitate  the shift  from 
treatment towards prevention. It also aims to address the challenges related to standardisation 
across  Member  States,  data  management, 
the 
comprehensiveness of screening programmes.  

integration  of  care  pathways  and 

Mobile and community-based health delivery models have already proven their value across 
Europe.  Several  EU  level  screening  initiatives117  demonstrate  that  bringing  screening  and 
health services directly to people increases uptake, builds trust and improves early detection 
rates. Expanding such models in the different Member States can strengthen prevention, early 
diagnosis and citizen engagement, particularly in rural or underserved areas. 

Flagship initiative: EU protocol on health checks for cardiovascular diseases  

In  2026,  the  Commission  will  propose  a  Council  recommendation  on  health  checks  for 
cardiovascular diseases to support a common approach for Member States in developing and 
implementing national health checks. The Commission intends to support the pilot-testing 
and  launch  of  the  EU  protocol  on  health  checks  in  Member  States,  as  well  as  launch 
awareness campaigns (‘Know Your Numbers’) to support this initiative. 

The proposal for a Council recommendation is envisaged to recommend screening towards 
specific  targets  that  support  the  general  and  intermediate  targets  linked  with  decreasing 
cardiovascular  disease  burden.  The  Council  recommendation  would  also  support  the 
identification and implementation of incentives to participate in screening programmes. 

The  Commission  intends  to  support  Member  States  in  the  piloting  of  mobile  screening 
outreach programmes to attain a high level of screening coverage levels. 

5.  PILLAR  3:  LIVING  WITH  CARDIOVASCULAR  DISEASES  -  IMPROVING  PATIENT 

TREATMENT AND CARE 

Prevention is key to reducing cardiovascular diseases, but access to high-quality, coordinated 
and  patient-centred  care  also  remains  essential.  Many  people  live  with  multiple  chronic 
diseases, and therefore require long-term, multidisciplinary support and care. Young people 
living with cardiovascular diseases have different needs from older people. Evidence shows 
that personalised treatments and care can reduce healthcare costs and improve quality of life118. 

117 EUCanScreen, Solace, Oncoscreen. 
118 Casassus, B. (2025). Patients with chronic diseases do better with personalised care, international survey finds. 
BMJ, 388, r365. https://doi.org/10.1136/bmj.r365. 

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Approaches to stratify patients, such as pharmacogenomics, can improve treatment outcomes, 
notably by predicting treatment response and reducing complications and adverse effects119.  

Clinical  guidelines  can  improve  healthcare  system  efficiency  and  support  better  patient 
outcomes.  However,  the  lack  of  common  standards  for  treatment  and  care  across  Member 
States leads to inequalities and inefficiencies. Patients need tools and guidance to monitor their 
health and follow treatment pathways, for example, on how to monitor their blood pressure, 
adhere  to  medication,  and  to  adopt  lifestyle  changes.  Digital  tools,  such  as  telemedicine, 
electronic health records and connected devices, can support self-management, continuity of 
care and access to care, especially in rural and underserved regions. These technologies also 
help prevent avoidable hospitalisations and support integrated and patient-centred care models. 
It  is  important  that  such  tools  are  accessible  for  older  people  and  persons  with  disabilities, 
ensuring interoperability with assistive devices. 

Integrated care models in primary care and community settings can, especially for people with 
multimorbidity,  such  as  living  with  chronic  kidney  disease,  diabetes  and  cardiovascular 
disease, reduce unplanned hospital admissions and improve quality of life while saving costs. 
Patient-centred approaches bring benefits, but such approaches are less frequently covered in 
national  cardiovascular  health  plans120.  The  feasibility  of  adapting  person-centred  digital 
cancer care models121 for cardiovascular care (e.g. cardiac rehabilitation and the monitoring of 
symptoms and health metrics), can be explored through multi-country pilot projects. It is also 
possible  to  enhance  and  roll  out  innovative  ICT-enabled  integrated  care  solutions  tailored 
specifically  to  advance  multi-disciplinary  health  and  care  for  patients  with  chronic  heart 
failure122. 

The Commission intends to: 

➢  set up an EU network of cardiovascular health centres to bring together expertise and 
facilitate the uptake of diagnosis and treatment, as well as rehabilitation and long-term 
care  and  effective  management,  including  adherence  to  treatment  and  medical 
advice123. 

People living with cardiovascular diseases often experience anxiety, fear of recurrence, and 
difficulty  adjusting  to  lifestyle  changes  and  long-term  treatments.  All  these  factors  can 
negatively  impact  quality  of  life  and  mental  health.  The  Commission’s  comprehensive 
approach  to  mental  health124  recognises  the  link  between  physical  and  mental  health,  and 
prioritises support for vulnerable population groups, including those with chronic conditions. 
The Commission will continue, through initiatives, such as the EU PROMENS125 training and 
exchange programme on mental health, to equip health, social care and education professionals 
with the skills needed to deliver integrated, multidisciplinary, and person-centred mental health 
care.  It  will  also  continue  supporting  the  education  and  training  of  future  specialists  in 

119 HT-ADVANCE119, a project funded under Horizon Europe; Shorbaji, A., Pushparaj, P. N., Al-Ghafari, A. B. 
et al. A narrative review of research advancements in pharmacogenetics of cardiovascular disease and impact on 
clinical implications. (2025). NPJ Genom. Med. 10, 54. https://pubmed.ncbi.nlm.nih.gov/40640196/. 
120 OECD report (2025)‘The state of cardiovascular health in the EU’.  
121 eCAN – Joint Action. 
122 INCAREHEART project funded under Horizon 2020.  
123 This will build on projects such as JACARDI and stakeholder-led projects. 
124 EU comprehensive approach to mental health. 
125 EU-PROMENS Project Page - EU-PROMENS. 

19 

 
 
 
cardiovascular  diseases,  and  interdisciplinary  training  in  well-being,  including  through 
European Universities alliances126. 

Rehabilitation after acute events, such as a heart attack or stroke, is vital in reducing the risk of 
death  and  disabilities  through  the  patient  pathway.  It  must  be  multidisciplinary  and 
comprehensive,  and  address  physical,  psychological  and  social  needs.  Rehabilitation  and 
continuity of care must be an integral part of national strategies. To ensure truly personalised 
care,  it  is  essential  to  apply  lived  experience  across  the  cardiovascular  disease  continuum, 
especially in management and care approaches. 

Medical devices and innovative technologies play an essential role in cardiovascular care. The 
Commission has proposed a revision of the EU legislative framework on medical devices127 
and in vitro diagnostic medical devices128, to simplify procedures and make requirements more 
cost effective and proportionate, while preserving a high level of protection for patients. This 
includes an accelerated regulatory pathway for breakthrough medical devices to ensure their 
timely availability for EU citizens. A pilot of the pathway is in preparation and will be launched 
in  early  2026.  It  will  place  particular  focus  on  cardiovascular  and  paediatric  breakthrough 
devices. 

Access  to  affordable,  safe  and  innovative  medicines  has  been  central  in  the  reduction  of 
deaths  from  cardiovascular  diseases.  The  revision  of  the  EU’s  pharmaceutical  legislation 
intends to modernise the regulatory framework, incentivise research and innovation, streamline 
the authorisation process and cut red tape, enabling faster authorisation and patient access to 
innovative treatments. It also aims to make the European Medicines Agency more agile and 
support access to essential cardiovascular-related medications. Moreover, the proposed Critical 
Medicines Act129 aims to improve the availability, supply and production of critical medicines 
within the EU, including certain medicines used in the treatment of cardiovascular diseases130.  

The proposal for a Biotech Act131 aims to bring biotech from the laboratory to the factory and 
then  onto  the  market,  with  a  focus  on  health,  to  accelerate  the  time-to-market  for  biotech 
products, and to boost the entire ecosystem to create a more innovation-friendly environment.  

In the EU, clinical trials are the foundation to generate the necessary evidence to enable safe, 
effective and innovative treatments that can improve cardiovascular outcomes. Decentralised 

126  EUTOPIA  Alliance, CIVIS  European  University  Alliance,  European  University  Alliance  for  Global 
Health, and EC2U Alliance  offers education and training relevant to public health. 
127 Proposal for a Regulation of the European Parliament and of the Council amending Regulations (EU) 2017/745 
and (EU) 2017/746 as regards simplifying and reducing the burden of the rules on medical devices and in vitro 
diagnostic  medical  devices,  and  amending  Regulation  (EU)  2022/123  as  regards  the  support  of  the  European 
Medicines Agency for the expert panels on medical devices and Regulation (EU) 2024/1689 as regards the list of 
Union harmonisation legislation referred to in its Annex I. 
128 Regulation (EU) 2017/746 of the European Parliament and of the Council of 5 April 2017 on in vitro diagnostic 
medical devices, OJ L 117, 5.5.2017, p. 176–332. 
129Critical medicines act - Public Health - European Commission. 
130  The  current  EU  List  of  Critical  Medicines  includes  medicines  that  are  relevant  for  cardiovascular  care. 
European Medicines Agency (EMA). 
131 COM(2025) 1022 [Proposal for a Regulation of the European Parliament and of the Council on establishing a 
framework of measures for strengthening Union’s biotechnology and biomanufacturing sectors particularly in the 
area  of  health  and  amending  Regulations  (EC)  No  178/2002,  (EC)  No  1394/2007,  (EU)  No  536/2014,  (EU) 
2019/6,  (EU)  2024/795  and  (EU)  2024/1938];  COM(2025)  1031[Proposal  for  a  Directive  of  the  European 
Parliament and of the Council amending Directives 2001/18/EC and 2010/53/EU as regards the placing on the 
market of genetically modified micro-organisms and the processing of organs]. 

20 

 
 
 
clinical  trials  supported  by  digital  health  technologies  are  key  to  increasing  patient 
participation,  streamlining  monitoring,  and 
improving  clinical  outcomes.  Enabling 
decentralised  approaches  is  particularly  important  in  cardiovascular  trials,  where  the  target 
population is often frail and therefore can be difficult to reach or retain.  The proposal for a 
Biotech Act aims to enable the authorisation of clinical trials with decentralised elements to 
simplify  the  rules  for  the  authorisation  and  conduct  of  clinical  trials,  to  shorten  the  time  to 
market for innovative medicines, including those used in cardiovascular care. The forthcoming 
Clinical Research Investment Plan will propose ways to facilitate funding for multi-country 
clinical trials and to further streamline European research infrastructures in the field of clinical 
research132. 

The  updated  harmonised  EU-level  best-practice  guidance  under  the  initiative  ‘accelerate 
clinical trials’ (ACT EU)133 is intended to help the uptake of decentralised elements in clinical 
trials by providing consistent, practical instructions for sponsors and trial sites across Member 
States.   

The  EU  Regulation  on  Health  Technology  Assessment134  supports  Member  States’ 
cooperation  on  the  clinical  assessment  of  new  health  technologies  comparing  them  with 
existing  treatments.  Since  the  start  of  2025,  advanced  therapy  medicinal  products  targeting 
cardiovascular  disease,  are  subject  to  joint  clinical  assessment.  Eligible  high-risk  medical 
devices  are  mainly  implantable  and  are  mostly  intended  for  treatment  of  cardiovascular 
diseases.  In 2026, joint  clinical  assessments  of high-risk medical  devices will start, such  as 
stents or cardiac valves, helping Member States to make faster and informed decisions on their 
pricing and reimbursement. Furthermore, the joint scientific consultations will provide health 
technology  developers  with  recommendations  on  their  development  plans  to  enhance  the 
quality of clinical studies. 

Funding  opportunities  are  available  to  Member  States  under  the  Technical  Support 
Instrument135, which provides tailor-made technical expertise to Member States to design and 
implement reforms136. In addition, relevant investments to improve population health outcomes 
in general, including for cardiovascular disease, can draw on funds made available through the 
EU cohesion funds. Member States have EUR 7.3 billion allocated from the European Regional 
Development  Fund  across  national,  regional  and  Interreg  programmes,  for  investments  in 
health infrastructure, equipment and cooperation across borders.   

Following  the  development  of  an  effective  early  detection  and  screening  approach,  the 
Commission intends to support the development and piloting of EU guidance on personalised 
treatment and monitoring of cardiovascular diseases, to ensure appropriate follow-up care. 
This  would  help  to  strengthen  cardiovascular  care,  support  data  collection,  facilitate  the 
integration of data across the EU and help develop more robust treatments and management 
strategies for cardiovascular diseases and their comorbidities.  

132 Strategy for European Life Sciences - Research and innovation.  
133 Recommendation paper on decentralised elements in clinical trials. 
134 Regulation (EU) 2021/2282 of the European Parliament and of the Council of 15 December 2021 on health 
technology assessment, OJ L 458, 22.12.2021, p. 1–32. 
135 Technical Support Instrument (TSI). 
136 Regulation (EU) 2021/240 of the European Parliament and of the Council of 10 February 2021 establishing a 
Technical Support Instrument, OJ L 57, 18.2.2021, p. 1-16. 

21 

 
 
 
Flagship initiative: proposal for a Council recommendation on personalised treatment 
and monitoring of cardiovascular diseases  

The  Commission  intends  to  propose,  in  2027,  a Council  recommendation  to  improve  the 
quality  and  consistency  of  personalised  and  integrated  care  pathways  for  cardiovascular 
diseases and related conditions, including using digital tools.  

This  proposal  is  envisaged  to  complement  and  inform  the  deployment  of  digital  and  AI-
based  solutions  supported  under  the  EU4Health  programme  (see  Chapter  6)  and  help  to 
improve access to essential treatments across the EU. 

6.  INTEGRATING DATA AND DIGITALISATION IN CARDIOVASCULAR HEALTH  

Digital  technologies  and  AI  are  reshaping  how  cardiovascular  diseases  are  prevented, 
detected,  and  managed.  They  can  transform  the  way  clinicians  and  patients  address  related 
conditions  such  as  hypertension,  diabetes  and  obesity,  which  are  key  risk  factors  for 
cardiovascular disease. By integrating genetic information, clinical and imaging data, lifestyle 
patterns and environmental determinants,  AI can  make it possible to more precisely predict 
cardiovascular  risk  and  tailored  interventions  accordingly.  Personalised  prevention  can 
strengthen existing population-based measures, empowering individuals to engage directly in 
managing their cardiovascular health. Digital and data-driven tools are essential to making this 
shift  a  reality.  They  enable  earlier  detection,  targeted  treatment  and  more  efficient  use  of 
healthcare resources, amplifying the impact of prevention strategies across Member States. 

The EU’s digital health transformation is entering a new phase, moving from data access and 
exchange towards practical, data-driven applications that improve prevention, diagnosis and 
care.  To  achieve  this,  the  Commission  intends  to  support  the  deployment  of  interoperable 
digital infrastructures and trustworthy AI solutions in alignment with the EHDS137, continuing 
from previous actions under EU4Health and Digital Europe programmes. This also requires 
clinically validated AI tools, supported by robust evidence on performance, safety and real-
world  effectiveness  in  clearly  defined  clinical  workflows.  In  parallel,  the  increasing  use  of 
consumer digital monitors can support individuals in tracking lifestyle and cardiovascular risk 
factors, provided information is used in a protected and responsible way.  

The rapid evolution of digital technologies and AI is opening new possibilities. What began as 
a focus on data accessibility, data sharing and interoperability must now be directed towards 
data-driven  health  applications  that  actively  support  prevention,  diagnosis,  and  healthcare 
optimisation, while increasing the efficiency and contributing to the sustainability of healthcare 
systems. The next stage of the EU’s digital health transformation should move beyond mere 
health data exchange to developing intelligent tools that can predict risk, guide personalised 
prevention,  automate  diagnostics,  enhance  clinical  decision-making  and  optimise  various 
aspects of health services. 

However, persistent barriers are limiting progress in cardiovascular medicine. Data relevant to 
cardiovascular diseases, including those linked to hypertension, diabetes and obesity and other 
risk factors, remain fragmented across care settings and data registries and therefore are not 
ready to use for effective health actions. They are often incomplete, lack standardisation or are 

137 Also connecting it to other relevant European dataspaces such as the Green Deal dataspace. 

22 

 
 
 
not sufficiently representative of diverse populations.  In most cases, cardiovascular datasets 
are  also  not  systematically  linked  with  environmental  risk  factor  data  (e.g.  air  pollution), 
although  such  integration  could  improve  risk  prediction  and  prevention  strategies.  This 
hampers  the  development  of  accurate  and  equitable  AI  models  for  cardiovascular  risk 
prediction and treatment optimisation. Interoperability gaps and limited integration of digital 
tools into cardiology workflows constrain their clinical validation and daily use. The lack of 
cross-border and longitudinal  data  of high  quality further limits  the ability to  generate real-
world evidence and to deploy trustworthy AI applications safely and effectively across the EU. 
Ensuring  that datasets  are  diverse,  and representative is  also important  to avoid  algorithmic 
biases,  as  AI  models  trained  on  incomplete  or  unbalanced  data,  risk  overlooking  sex-  and 
gender-related differences in symptoms, risk factors and treatment responses138.   

The  Safe  Hearts  Plan  shifts  the  focus  from  fragmented  pilot  initiatives  to  coordinated 
deployment  at  scale.  The  plan  aims  to  mobilise  diverse,  high-quality  health  data  through 
interoperable  digital  infrastructures,  and  to  promote  trustworthy,  clinically  validated  AI 
solutions. It can support the better deployment of public computational infrastructures, and the 
sharing  of  health  applications.  It  will  reinforce  prevention,  strengthen  clinical  and  care 
pathways; reduce inequalities across regions, and support personalised, data-driven treatment 
of cardiovascular diseases. It will also enhance EU’s capacity to innovate and compete globally 
in digital health and cardiovascular medicine. 

High-quality,  diverse  and  representative  health  data  are  essential  for  advancing 
cardiovascular  research,  innovation,  and  patient  care.  However,  most  Member  States  lack 
comprehensive  national  registries  for  cardiovascular  disease  and  diabetes,  and  this  lack  is 
constraining  robust  clinical  research,  the  development  of  personalised  care  solutions,  and 
informed policymaking.  

The EHDS is supported by EU investments in infrastructure and standards and is a cornerstone 
of the EU’s data-driven innovation, in the cardiovascular field. The EHDS sets up a common 
framework that will facilitate efforts to securely access and link clinical, lifestyle, and genomic 
data  across  the  EU.  It  will  connect  and  unlock  the  value  of  initiatives  such  as  1+  Million 
Genomes139  and  Genome  of  Europe140,  turning  their  assets  into  interoperable  resources  for 
prevention,  care  and  research.  This  will  enable  earlier  risk  identification,  better  patient 
stratification, and more targeted interventions.  

AI is transforming cardiovascular care through earlier detection, more accurate risk prediction, 
and personalised treatment. The AI Act sets clear rules for high-risk AI systems in healthcare, 
and  the  AI  Continent  Action  Plan141  and  Apply  AI  Strategy142  will  guide  investment  and 
deployment.  This  will  foster  innovation  and  competitiveness  in  health  and  other  strategic 
sectors. 

The  Commission  is  funding  multi-country  real-world  evaluations  and  the  responsible 
deployment of AI tools in clinical settings143 under several actions supported from EU4Health 

138 For example, the project CARAMEL funded under Horizon Europe.  
139 European '1+ Million Genomes' initiative. 
140 Genome of Europe project launched: the first step towards a European reference genome. 
141 The AI Continent Action Plan. 
142Apply AI Strategy. 
143 SHAIPED is funded under the Digital Europe Programme. 

23 

 
 
 
and Digital Europe programmes. The application of AI to medical imaging represents one of 
the  most  mature,  high-impact,  and  rapidly  evolving  domains144.  These  efforts  are 
complemented by testing and experimentation facilities under the Digital Europe Programme, 
and an EU network of advanced screening  centres under the Apply AI strategy145 acting as 
testbeds for the deployment of multimodal AI-based imaging solutions in cardiovascular and 
cancer applications.  

Member  States  may  request  tailored  technical  assistance  under  the  Technical  Support 
Instrument  to  prepare  governance,  regulatory  and  organisational  reforms  that  enable  the 
integration of AI in cardiovascular care, in line with the EHDS Regulation and other relevant 
EU regulatory frameworks. 

Building on this momentum, the Commission will launch a flagship initiative to advance AI 
and data-driven solutions for cardiovascular and related diseases, enabling earlier detection, 
personalised care and rehabilitation, including for rare and complex cases.  

Flagship  initiative:  incubator  for  innovation  and  integration  of  AI  and  digital 
technologies in cardiovascular healthcare 
The  Commission  will  support  a  EUR  20  million  flagship  initiative146  to  accelerate  the 
deployment  and  application  of  AI  and  data-driven  tools  for  early  detection,  personalised 
prevention, integrated care for cardiovascular diseases, diabetes and obesity. The incubator 
will prioritise real-world uptake, cross-border validation and integration in care pathways, 
including for rare and complex cases. The Commission will scale up successful outcomes to 
support the broader use of digital tools for personalised prevention and management.  

The  flagship  initiative  aims  to  identify  a  common  definition  of  a  core  set  of  technical 
specifications for datasets to be used in AI development and validation, by 2030, thus 
ensuring equitable access to these innovations across participating Member States. 

The flagship initiative also aims to publish a blueprint for cardiovascular AI deployment, 
guiding validation, clinical integration and monitoring of AI tools in cardiology. 

7.  REACHING EVERY CITIZEN 

Women are disadvantaged by significant inequalities in cardiovascular care because they are 
often  underdiagnosed,  undertreated  and  underrepresented  in  clinical  trials147.  This  leads  to 
delayed diagnosis and treatment148. Health literacy campaigns are vital to raising among both 

144 European Commission: Joint Research Centre (2025(, AI-driven innovation in medical imaging – Focus on 
lung cancer and cardiovascular diseases;  Targeted initiatives will build on projects e.g. COMPASS AI, the EHDS 
infrastructures, ICUdata4EU and INDICATE.  
145 Apply AI Strategy; Home - TEF-Health - Testing and Experimentation Facility for Health and Robotics. 
146 EU4Health 2025 work programme.  
147 Zannad, F., Berwanger, O., Corda, S., et al.  (2024). How to make cardiology clinical trials more inclusive. 
Nature Medicine, 30, 2745–2755. https://doi.org/10.1038/s41591-024-03273-3.  
148 El Bassiri, Y., Azeem, A., Sharma, A. C., Hassan, M., Hassan, M., & Omari, I. (2025). Gender disparities in 
ischemic  heart  disease  management:  Underdiagnosis  in  women  and  differences  in  treatment.  Cureus,  17(8), 
e89912. https://doi.org/10.7759/cureus.89912; Eurostat; ESC Statement - Lancet Commission Report - CVD in 
Women. 

24 

 
 
 
patients’ and health professionals’ awareness of specific symptoms and risks149. Young people 
are central to prevention efforts. Actions must start early and reflect their needs, ensuring a 
cross-sectoral  approach 
improving  young  people’s  health.  Socio-economically 
disadvantaged  groups  experience  poorer  health  outcomes  and  limited  access  to  preventive 
care150. Addressing these inequalities requires a coordinated approach across the care pathway.  

to 

Flagship initiative: addressing inequalities 

The Commission intends to: 

➢  develop an EU cardiovascular health inequalities dashboard that is modelled on the 

European Cancer Inequalities Registry151 and based on existing data; and  

➢  invest in research under Horizon Europe to advance the understanding of sex and/or 
gender-specific mechanisms of cardiovascular diseases, including, risk factors and 
disease pathway152. 

8.  ADDRESSING THE RESEARCH AND INNOVATION GAP 

To date, the EU has invested almost  EUR 2.3 billion in cardiovascular and related research 
through  the  EU  framework  programmes  for  research  and  innovation153.  The  funding  has 
supported research on the development of more effective preventive, diagnostic, therapeutic 
and monitoring approaches to improve the health of citizens. 

However,  breakthrough  therapeutic  innovation  remains  limited  for  cardiovascular  diseases. 
Few new therapies have reached the market in recent years154. Most advances have built on 
existing treatments rather than developing new ones155.  

There  is  a  need  to  deepen  our  understanding  of  the  disease  mechanisms,  early  prevention, 
personalised  risk  prediction,  and  treatment  optimisation  to  deliver  effective,  patient-centred 
and  tailored  care  and  to  develop  innovative  diagnostics,  medicines,  and  digital  tools. 
Several systemic barriers, including the high cost and complexity of large-scale clinical trials 
and fragmented research efforts, further discourage private sector engagement. Furthermore, 
specific  efforts  need  to  be  made  to  understand  the  mechanisms  leading  to  cardiovascular 
differences between men and women.   

To  address  these  challenges,  EU  funded  ongoing  public  and  private  initiatives  like 
the Innovative Health Initiative156 (IHI) foster collaboration between academia, industry, and 
clinicians  to  co-develop  new  therapies  and  technologies  for  the  prevention,  detection, 

149 Al Hamid, A., Beckett, R., Wilson, M., et al. (2024). Gender bias in diagnosis, prevention, and treatment of 
cardiovascular diseases: A systematic review. Cureus, 16(2), e54264. https://doi.org/10.7759/cureus.54264.  
150 OECD report (2025) ‘The state of cardiovascular health in the EU’ - Full Report: The State of Cardiovascular 
Health in the European Union | OECD. 
151 European Cancer Inequalities Registry (ECIR). 
152 Horizon Europe Cluster 1 2026-2027 work programme: indicative funding EUR 40 million. 
153 Horizon 2020; Horizon Europe. 
154 Global Trends in R&D 2024: Activity, productivity, and enablers - IQVIA. 
155  Jackson,  N., Atar,  D.,  Borentain,  M.,  et  al.  (2016).  Improving  clinical  trials  for  cardiovascular  diseases: A 
position  paper  from  the  Cardiovascular  Round Table  of  the  European  Society  of  Cardiology.  European  Heart 
Journal, 37(9), 747–754. https://doi.org/10.1093/eurheartj/ehv213. 
156 Innovative Health Initiative Joint Undertaking. 

25 

 
 
 
diagnostic,  treatment  and  care  of  cardiovascular  diseases  and  other  chronic  diseases.  IHI  is 
launching a large project that brings together municipalities across Europe with researchers, 
healthcare  providers,  pharmaceutical  and  medical  technology  industry  to  have  a  better 
understanding of how cardiovascular care is organised and delivered, identify best practices, 
and promote integrated, patient-centred solutions across the EU. 

A  better  understanding  of  microbiomes,  through  a  One  Health  approach,  will  create 
opportunities to improve and create new products for health, as outlined in the Strategy for 
European Life Sciences. The PROPHET project157, funded by Horizon Europe, will deliver, by 
the end of 2025, a Personalised Prevention Strategic Research and Innovation Agenda (SRIA) 
to  support  the  definition  and  implementation  of  innovative,  sustainable  and  high-quality 
personalised strategies that are effective in preventing chronic diseases. The PROFID158 project 
on  the  prevention  of  sudden  cardiac  death  after  myocardial  infarction  by  defibrillator 
implantation  has  revealed  important  data  on  the  effectiveness  of  defibrillator  implantation. 
Such initiatives need to be continued to enable decision makers to choose the most efficient 
health  technologies  in  the  field  of  cardiovascular  treatment  and  care.  The  European  Virtual 
Human Twins initiative159 supports actions that advance personalised cardiovascular care and 
accelerate  the  adoption  of  next-generation  digital  solutions.  Such  initiatives  need  to  be 
continued  to enable decision  makers to  choose the most efficient  health technologies in  the 
field of cardiovascular treatment and care.  

Member States and regions could use the allocated cohesion funds from the European Regional 
Development  Fund160  to  strengthen  their  research  and  innovation  ecosystems  on  health. 
Moreover, the Interregional Innovation Investments (I3) Instrument161 could help to scale up 
innovative  health  solutions,  enhance  territorial  linkages  and  better  integrate  research  and 
innovation across countries and regions. 

Public procurement is a powerful catalyst for innovation tailored to user needs. EU funding 
programmes 
innovation 
incentivising suppliers to co-create with procurers and deliver innovative solutions addressing 
the needs of healthcare professionals. 

to  foster  demand-driven 

innovation  procurement 

invest 

in 

To  strengthen  research  on  personalised  prevention  and  to  unlock  the  full  potential  of 
innovation,  the  EU  needs  a cardiovascular  research  and  innovation  roadmap  that 
streamlines funding, expands research capacity, and targets unmet needs.  

Flagship initiative: closing the cardiovascular research gap 

The Commission intends to launch a flagship initiative to address the research and innovation 
gap for cardiovascular diseases with the aim of improving understanding of cardiovascular 
disease  mechanisms  and  support  the  uptake  of  innovative  tools  for  personalised  risk 
prediction and the optimisation of treatment.  

157 PROPHET. 
158 PROFID PROJECT. 
159Virtual Human Twins initiative for health and care. 
160 European Regional Development Fund (ERDF) - European Commission. 
161  Interregional  Innovation  Investments  (I3)  Instrument  -  European  Innovation  Council  and  SMEs  Executive 
Agency (EISMEA). 

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This will involve: 

➢  establishing  a  Cardiovascular  Disease  Research  and  Innovation  Roadmap  to 
accelerate innovation and translation of research into practice on risk prediction, and 
personalised and digital approaches for early detection and screening, especially for 
women and vulnerable groups162; 

➢  research on innovative healthcare interventions for cardiovascular diseases and 
diabetes,  including  AI  and  digital  approaches,  to  improve  risk  prediction,  early 
detection  and  screening  practices  through  personalised  prevention  and  care 
pathways163; 

➢  research  on  the  role  of  sustainable  and  healthy  diets  for  cardiovascular  disease 
prevention with the support of digital tools, including the link between nutrition, the 
gut microbiome and cardiovascular disease164; 

➢  research  on  cardiovascular,  metabolic  and  renal  diseases,  under  the  European 

Partnership for Personalised Medicine165; 

➢  funding  of  Public  Procurement  of  Innovation  for  personalised  healthcare 

approaches including cardiovascular diseases166; 

➢  pre-clinical research and multi-country clinical trials on cardiovascular diseases, 
nanomedicine, nutrition and healthy lifestyles under the European Partnership that 
fosters a European Research Area for health research (ERA4Health)167.  

9.  WORKING TOGETHER: A FRAMEWORK FOR COLLABORATION AND MONITORING 

Tackling cardiovascular diseases requires a multi-stakeholder and cross-sectoral effort, that 
brings  together  policymakers,  health  professionals,  researchers,  healthcare  institutions, 
industry, civil society, and people with lived experience, to drive innovation, share knowledge, 
and place citizens at the heart of our solutions. 

The Youth Advisory Group168 of the Prevent NCD joint action provides a blueprint for how 
young people’s perspectives can be integrated, including at national level, into the prevention 
and care of NCDs, such as cardiovascular diseases169.  

The Commission intends to: 

➢  continue to develop actions with Member States through the Expert Group on Public 
Health170, which is the main forum for discussions on the prevention and management 
of cardiovascular diseases and other NCDs; 

162 Horizon Europe Cluster 1 work programme 2026-2027: indicative funding EUR 2 million. 
163 Horizon Europe Cluster 1 work programme 2026-2027: indicative funding EUR 64 million. 
164 Horizon Europe Cluster 6 work programme 2026-2027: indicative funding EUR 12 million. 
165 Horizon Europe: indicative funding EUR 38 million. 
166 Horizon Europe Cluster 1 work programme 2026-2027: indicative funding EUR 24.5 million. 
167 European Partnership fostering a European Research Area for health research (ERA4Health). 
168 JA PreventNCD Youth Advisory Group. 
169 The  Commission  held  a  discussion  with  a  group  of  young  people  with  lived  experience  who  shared  their 
personal  stories  on  living  with  cardiovascular  diseases  or  related  conditions  -  Cardiovascular  health  -  Public 
Health - European Commission. 
170 Expert Group on Public Health - Public Health - European Commission. 

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➢  create a network of cardiovascular and diabetes experts171, including medical societies 

and patient organisations; 

➢  support targeted actions172  to  reduce cardiovascular disease and diabetes risk among 

vulnerable groups, especially women; 

➢  strengthen collaboration between cardiovascular experts and cancer experts to support 

the joint efforts on prevention of diseases; 

➢  support  a  thematic  network under  the  EU  Health  Policy  Platform173  will  enable 

sustained stakeholder dialogue and action, focusing on young people; 

➢  launch a call for evidence-based public health interventions on cardiovascular diseases 
and  related  risk  factors  including  diabetes  and  obesity  under  the  EU  Best  Practice 
Portal174. 

Cardiovascular diseases are a global public health challenge. They are the leading cause of 
death worldwide and account for 32% of all global deaths. Tackling this challenge requires 
collaboration  with  countries  that  share  common  challenges.  At  the  global  level,  the 
Commission  will  cooperate  in  the  fight  against  cardiovascular  diseases  and  other  NCDs  by 
accelerating progress through joint projects to reduce their burden through the exchange of best 
practices  and  approaches  in  the  context  of  global  collaboration  with  non-EU  countries, 
international partners, global health institutions and actors, and stakeholders, including in the 
context  of  the  Global  Alliance  for  Chronic  Diseases  (GACD),  which  is  co-funded  by  the 
Commission175 

10. CONCLUSION  

The  Safe  Hearts  Plan  contains  concrete  and  ambitious  actions  that  will  tangibly  improve 
people’s cardiovascular health and quality of life, reduce the burden of cardiovascular diseases, 
diabetes and obesity, by stepping up personalised prevention, introducing early detection and 
screening programmes, and applying innovative approaches to improve access to treatment, 
care and rehabilitation.  

The challenge ahead of us affects everybody. Success depends on the active engagement of 
Member  States,  researchers,  innovators,  industry,  civil  society,  healthcare  providers  and 
professionals, patients, academia, and international partners, working together at local, national 
and EU level. This collective commitment is essential to reduce health inequalities between 
Member States, population groups and genders. The Safe Hearts Plan lays the foundation for 
sustained, patient-centred action at national and EU level.  

Together, these efforts will build a healthier and more resilient population, driving innovation 
and competitiveness across the EU.  

171 Direct grants to Member States funded with EUR 5 million under the EU4Health 2025 work programme. 
172 These action grants will receive EUR 2 million in funding under EU4Health 2025 work programme. 
173 EU Health Policy Platform - EU Health Policy Platform. 
174 Best practices Portal. 
175 Global Alliance for Chronic Diseases (GACD). 

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