The past two years have put our healthcare systems in Europe to the test, as the COVID-19 pandemic brought an added setback on top of the public health challenges that countries were already facing.

Each wave of COVID has brought new challenges to systems struggling with stretched services. System pressures have distracted Member States from their core health priorities, including diagnosis and management of chronic disease. Europe’s #1 cause of death is cardiovascular disease (CVD), and attention has been diverted through the COVID crisis. This is despite the fact that CVD is a clear predictor of poorer outcomes for people impacted by COVID, but also that COVID has significant cardiovascular impacts.

Today, CVD causes 37% of all deaths in the EU. CVD impacts the lives of 60 million Europeans. It is Europe’s leading cause of death in people under 65. As the ageing of Europe’s population progresses, we would expect these figures to increase further unless new and decisive actions are taken by public health authorities.

For policymakers this should be a cause of great concern – both for population health and its effect on health systems. CVD costs the EU 210 billion Euros every year, including the direct costs of healthcare, and also the considerable productivity losses of people prematurely leaving the workforce, and the indirect costs of caregiver support.

Despite ranking as Europe’s #1 killer, efforts to prevent and treat CVD lag behind other diseases. CVD-focused public health information and actions to raise awareness are lower than for other conditions. Despite the high impact of CVD, there is low public awareness of its risks. This is in stark contrast to cancer – Europe’s #2 cause of death. Here, stakeholders have access to a wealth of information on cancer diagnosis, prevention, and cure. Today most EU countries have cancer initiatives, including screening programs in breast, cervical and colorectal cancer. Very few have national cardiovascular strategies.

The Beating Cancer Plan is inspiring – but heart disease needs are fundamentally different

The Beating Cancer Plan (BCP) gives Europe an excellent starting point to show that solidarity against our most prevalent conditions can galvanise society to act. Some factors that prevent non-communicable diseases (NCDs) are relevant to both cancer and CVD – for example stopping smoking, reducing sugars and salts, and increased physical activity. But for CVD, these are the tip of the iceberg. CVD is often present in parallel with other chronic conditions, including obesity, diabetes, and hypertension. The parallel risk of combined conditions leads to greatly increased risks of compromised health or premature death. An effective ‘Beating CVD’ plan for Europe should embrace a focused approach, ensuring that appropriate identification, management and treatment is the mainstay of those living with CVD and related conditions.

Towards a galvanized European CVD community

2021 saw the launch of new initiatives calling to reduce cardiovascular disease burden. For example, the European Alliance for Cardiovascular Health (EACH) is calling on EU policymakers to develop an EU CVD Plan.

Also in 2021, a session at the European Health Forum Gastein assessed how to progress toward a ‘Beating CVD’ plan for Europe. This group of leading experts discussed the elements of a Europe-wide CVD plan. Key issues highlighted by these experts were:

• Healthcare systems need to shift their focus from reactive to prevention first, then cure.
• Education and awareness will make a difference; CVD is deadlier than cancer but people fear it less.
• EU-level CVD policies can inform people to make healthy lifestyle choices.
• Investments in research, development and new technologies are vital to reducing CVD-related mortality.

Likewise, the WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCD-GAP) directly supports the conceptual basis for a focused CVD plan. However, in 2021 a mid-term evaluation of the Plan was reported to the 74^th World Health Assembly, identifying major limitations, and made recommendations to place Member States on a sustainable path to achieve their Sustainable Development Goal (SDG) target 3.4.1 by 2030.