New report highlights widening cardiovascular health inequalities across Europe

Cardiovascular disease (CVD) remains one of Europe's biggest health challenges, according to new data from the European Society of Cardiology (ESC) Atlas of Cardiology, published in the European Heart Journal.

The ESC Atlas of Cardiology celebrates its 10-year anniversary with the fifth edition of the ESC Atlas report. The publication again demonstrates that CVD is the most common cause of death in more than 50 ESC member countries studied. "The new report shows that CVD was responsible for more than 3 million deaths and 68 million healthy life-years lost annually. These are not abstract statistics − they represent lives lost too early, people living with long-term illness and health systems under growing pressure," said Professor Adam Timmis, co-first author of the publication.

In line with previous ESC Atlas editions, a central message is the persistent and avoidable inequalities in cardiovascular risk, outcomes and access to care. Middle-income countries continue to experience roughly double the mortality of high-income nations.

Europe does not have one cardiovascular reality – ESC Atlas data show that the CVD burden is uneven across ESC countries. While there has been real progress in some countries, in many there are important gaps related to access to advanced diagnostics, procedures and specialist workforce."

Professor Steffen Petersen, co-first author

New ESC Atlas data emphasise the growing importance of wider determinants of cardiovascular health, with air pollution levels twice as high in middle-income countries as in high-income countries. In addition, the prevalence of vaping, particularly in young people, underscores the lack of evidence supporting e-cigarettes as an effective smoking cessation tool. The use of e-cigarettes increases the likelihood of later cigarette smoking among minors,² strengthening the need for clearer regulation and youth-focused prevention policies.

The high prevalence of clinical risk factors such as hypertension, dyslipidaemia, obesity and diabetes remains a concern. Professor Timmis noted: "The progress that has been made in reducing the CVD burden across some ESC member countries is at risk of being offset by the epidemic of obesity and diabetes. The scale of the healthy life-years lost due to modifiable risk factors supports urgent efforts to improve prevention across a person's life and aid early detection and guideline implementation. The medical and economic costs of inaction are huge."

Female disadvantage is evident across many of the variables studied, including lower access to key cardiac procedures. While the ESC Atlas report highlighted that 40% of cardiologists are women, only 11.5% of interventional cardiologists are women, with even fewer women in cardiac surgery (8.8%).

"A major strength of the ESC Atlas is the contributions of the ESC National Cardiac Societies, which provide not only a picture of disease burden, but also a practical representation of how cardiovascular care is delivered, to whom and by whom in different countries," explained Professor Petersen, who concluded: "The ESC Atlas is not just about describing the problem. Mapping these gaps is the first step towards closing them with targeted policy action, guiding investment and supporting national cardiovascular strategies that reduce inequalities."

In addition to the fifth published edition, interactive data dashboards showing inequalities in CVD across more than 50 countries are freely available at eAtlas.

Previous editions of ESC Atlas data were presented to EU health ministers as part of discussions that led to the recent launch of the Safe Hearts Plan, which aims to anchor CVD at the centre of Europe's public health agenda.