Professor Susanna Price, Chair of the European Society of Cardiology’s Advocacy Committee, advocates for improved early detection and addressing inequalities in cardiovascular disease prevention, the leading cause of death worldwide
According to the World Health Organization (WHO), an estimated 17.9 million people died from cardiovascular diseases (CVDs) in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke. Cardiovascular disease (CVD) remains the leading cause of death in Europe and worldwide, responsible for 34% (1) of deaths across the European Union (EU), with women bearing a disproportionate burden. Despite decades of progress, persistent inequalities in prevention, diagnosis, and care demand urgent and coordinated action to protect population health and promote equitable outcomes.
Inequalities in CVD
Across the EU, 62 million (1) people are currently living with CVD, and around 20% of all premature deaths before age 65 are due to cardiovascular conditions. Gender disparities are particularly harsh: women experience higher mortality rates after acute cardiovascular events compared to men, with CVD accounting for 37% of female deaths compared to 31% of male deaths. Yet public perception continues to underestimate women’s risk, often mislabelling CVD as a ‘men’s disease.’
Inequalities are not limited to gender. Geographical and socio-economic disparities remain widespread. Mortality rates from heart disease and stroke vary dramatically between countries; for example, age-standardised death rates for heart disease are up to 13 times higher in women in Lithuania compared to France. (1) Rural communities and economically disadvantaged groups also suffer from higher rates of risk factors, reduced access to preventive services, and poorer outcomes.
Identifying CVD risk factors early
Early identification of cardiovascular risk factors offers one of the most effective strategies for preventing disease onset and reducing mortality. Risk prediction models aim to facilitate timely detection through structured, evidence-based screening across the life course. However, to maximise impact, these models must integrate social determinants of health, sex-specific factors, and genetic predispositions. Special attention should be paid to the early identification of women at risk, particularly those affected by pregnancy-related conditions such as maternal cardiac disease, which complicates between 1–4% of pregnancies. (2)
The role of digital tools in cardiac care
Digital innovation presents significant opportunities to transform CVD research and care; it is necessary to harmonise data collection, improve the representativeness of datasets, and reduce gender bias in Artificial Intelligence tools. Leveraging these technologies can enable earlier, more accurate diagnoses, more personalized risk assessments, and targeted interventions. Nonetheless, technological advances must be implemented inclusively to avoid reinforcing existing disparities. Digital tools should be accessible to all communities, regardless of socio-economic status, geography, or age, and should be accompanied by robust measures to protect individual privacy and security.
Public awareness remains a critical pillar of prevention. Despite the high burden of CVD among women, knowledge about female-specific symptoms remains limited. This gap in understanding leads to delayed diagnosis and treatment, and poorer outcomes. Public health campaigns should challenge stereotypes, educate on early warning signs in women, and promote regular cardiovascular health checks throughout life.
Improving cardiovascular health outcomes also demands that data aggregation efforts include systematic gender-disaggregated reporting. Future clinical trials should strive for gender parity, and regulatory processes should require the presentation of sex-specific results before authorizing new treatments. Ensuring women’s experiences are central to research design, policymaking, and health service delivery will help correct systemic biases and achieve better outcomes for all.
CVD prevention across the life course
A life-course approach to prevention, beginning from childhood and spanning across adulthood into older age, is essential to address CVD’s multifactorial nature. Strategies must target both modifiable lifestyle factors, such as smoking, diet, and physical inactivity, and non-modifiable risk factors, including genetic predispositions.
On 23rd of April, 2025, the European Alliance for Cardiovascular Health (EACH) presented at the European Parliament its roadmap (3) for a European Cardiovascular Health Plan, putting forward several proposals to strengthen cardiovascular disease prevention across Europe. EACH is an alliance that unites European and international organisations, currently comprising 21 members, to engage in joint activities aimed at promoting cardiovascular health as a policy priority at the EU level. It serves as a platform for aggregating knowledge and expertise from key stakeholders active in the field of cardiovascular health.
Key recommendations presented by EACH include the creation of a European Cardiovascular Health Knowledge Centre to address data fragmentation, a European Cardiovascular Health Observatory to identify and share best practices, and the introduction of a structured European Cardiovascular Health Check to support early detection throughout the life course. Further proposals highlight the need for National Cardiovascular Health Action Plans tailored to individual Member States, stronger EU-wide action on primordial and primary prevention, and the establishment of an incubator to accelerate digital innovation in cardiovascular care. A dedicated Cardiovascular Health Research Agenda is also recommended to drive basic, translational, and implementation science, with a particular focus on gender-specific risks and health inequalities.
Together, these initiatives could form the backbone of a coordinated European approach to cardiovascular health, especially with the upcoming European Cardiovascular Health Plan, announced by Commissioner Várhelyi in December 2024. However, their success will depend on decisive political action and sustained investment. By implementing a holistic, inclusive, and data-driven strategy for cardiovascular disease prevention, Europe has a historic opportunity to turn the tide against its biggest killer. Reducing inequalities in prevention, diagnosis, and treatment must be placed at the centre of these efforts, ensuring that no individual, regardless of gender, geography, or socio-economic status, is left behind.
References
- ESC Atlas of Cardiology – EU 27 cardiovascular realities 2025,
- Catherine E Wright, et al., 2023, Pregnancy loss and risk of incident CVD within 5 years: Findings from the Women’s Health Initiative,
- EACH, A European Cardiovascular Health Plan: The Roadmap,
