Changes from plenary report to adopted text

L. whereas obesity is responsible for almost a quarter of treatment costs for CVDs and leads to substantial societal losses in terms of lower workforce participation and productivity and higher dependency on social and health services;

M. whereas mental health related diseases and symptoms such as depression, anxiety, anger and hostility, as well as acute or chronic stress, are factors that increase the risk of CVD; whereas current recommendations call for the standardised screening of depression and the implementation of an appropriate therapeutic plan in patients with cardiac conditions; whereas a lack of psychosocial well-being in the population also constitutes a cardiovascular risk factor, as it is associated with poorer cardiovascular health and more adverse clinical outcomes in CVD; whereas psychosocial factors are closely linked to overall cardiovascular risk, often influencing behaviours such as tobacco use and levels of physical activity;

N. whereas metabolic dysfunction-associated steatotic liver disease remains an under-recognised driver of CVD, affecting more than 25 % of adults

in the EU;

O. whereas persistent and widening inequalities in cardiovascular health outcomes exist between and within Member States, between women and men, between urban and rural areas, and among vulnerable populations, including migrants, older people, people with disabilities, people with rare diseases and multiple morbidities, unemployed people and socio-economically disadvantaged populations; whereas environmental and occupational health risks are unevenly distributed across society;

P. whereas CVDs increasingly and disproportionately affect certain migrant populations, driven by social, environmental and behavioural factors, and compounded by several factors including limited health literacy and restricted access to healthcare due, in particular, to language barriers, lack of information on available services and cultural differences; whereas there is a persistent under-representation of vulnerable populations, including migrants, in clinical trials;

Q. whereas children and adolescents are consistently diagnosed too late for type 1 diabetes and familial hypercholesterolemia, leading to serious complications, delayed care and poorer long-term health outcomes; whereas type 1 diabetes affects around 1 in 200 individuals, yet 40 % of children with type 1 diabetes are diagnosed with diabetic keto-acidosis, a potentially life-threatening condition; whereas familial hypercholesterolemia affects around one in 250 individuals, yet less than 10 % of cases are detected and diagnosis is often delayed until after a cardiovascular event has occurred;

R. whereas evidence from EU agencies and international bodies demonstrates that, in addition to lifestyle and environmental factors, work-related exposures contribute to the development and aggravation of CVDs; whereas EU-level risk assessments and occupational safety and health frameworks have traditionally focused on cancer, respiratory and acute toxic outcomes, while cardiovascular effects of occupational exposure remain under-recognised and insufficiently addressed;

S. whereas women are consistently underdiagnosed and undertreated for CVDs owing to biological risk factors including adverse pregnancy outcomes, and to gender bias in health policy, diagnosis, treatment and clinical research, including the persistent under-representation of women in clinical trials, leading to delayed care and poorer health outcomes;

T. whereas several reproductive health conditions, such as infertility attributed to ovulatory disorders and endometriosis, hypertensive disorders of pregnancy, hormonal contraceptives and the transition to menopause, are linked to increased cardiovascular risk; whereas scientific evidence indicates that polycystic ovary syndrome is the most common endocrine disorder of women of reproductive age and is associated with an increased risk of hypertension, stroke and CVD, independently of body mass index; whereas endometriosis has been found to be associated with an increased risk of ischaemic heart disease and cerebrovascular disease;

U. whereas research into CVDs and associated risk factors such as preeclampsia and gestational diabetes receives low funding in proportion to the health burden that they represent;

V. whereas CVDs are still perceived as a male problem; whereas women are five times less likely to consider heart disease as a major health issue or leading cause of death; whereas women are less likely to undergo cardiovascular screening; whereas many commonly used cardiovascular medicines lack sufficient gender-disaggregated safety data, for example on use during pregnancy, which limits treatment options and exposes pregnant women to increased health risks;

W. whereas a coordinated and comprehensive EU cardiovascular health plan can support Member States in accelerating the implementation of integrated evidence-based prevention measures for CVDs and associated risk factors, including secondary prevention and systematic follow-up, strengthening healthcare systems, enhancing resilience, extending cross-border cooperation, raising awareness about symptoms and the actions to take in response to cardiovascular events, providing timely and affordable access to medicines, and reducing inequalities in cardiovascular outcomes and interconnected comorbidities across the EU;

X. whereas most deaths from CVD are preventable and 74 % of the CVD burden can be attributed to modifiable risk factors; whereas many of these risk factors – including tobacco use, harmful alcohol consumption, particularly at levels exceeding scientifically established health recommendations, unhealthy diets, physical inactivity and environmental exposures – are shared with other NCDs, notably cancer;

Y. whereas some CVD deaths are also attributable to non-modifiable risk factors including genetically inherited conditions;

Z. whereas vaccination can constitute an effective health intervention to support the prevention and management of CVDs by providing for immunisation and therefore lowering the risk of infection-triggered cardiovascular events and related complications, and is an important measure to improve survival, decrease hospital admissions and enhance patients’ quality of life; welcomes the forthcoming Council recommendation on vaccination against respiratory infections as part of CVD prevention strategies;

AA. whereas strong and adequately resourced primary care, effective prevention and risk-based early detection are essential for reducing avoidable deaths and disability and are the most cost-effective strategy to ensure the sustainability of universal healthcare;

AB. whereas most EU countries face a shortage of general practitioners and medical specialists and an uneven distribution of healthcare professionals across regions, driven by demographic pressures and challenging working conditions, including an ageing health workforce and difficulties in attracting and retaining professionals, which undermines timely patient access to medical advice and care, and the sustainability of healthcare systems; whereas according to current estimates, the future number of cardiologists will be insufficient to meet the growing demand for cardiovascular prevention and care, while psychosocial consequences of CVD are also inadequately covered;

AC. whereas out-of-hospital cardiac arrest remains a leading cause of preventable mortality; whereas survival depends critically on the immediate recognition of cardiac arrest, early bystander cardiopulmonary resuscitation, rapid defibrillation and timely advanced life support; whereas improving community response and emergency medical services performance is essential to reduce avoidable cardiovascular deaths;

AD. whereas the speed of diagnosis and treatment plays a key role in mitigating the long-term effects of cardiovascular accidents; whereas many cardiovascular accidents are misdiagnosed, thus creating higher risks of recurrence and long-term health disorders for patients; whereas in acute coronary syndromes, and in particular ST-segment elevation myocardial infarction, outcomes depend strongly on the time to reperfusion; whereas delays in opening occluded coronary arteries increase myocardial damage, heart failure risk and mortality; whereas reducing system delays requires coordinated networks from first medical contact to definitive reperfusion;

AE. whereas reliable and timely access to essential cardiovascular medicines is a cornerstone of effective prevention and care for CVD;

AF. whereas in certain circumstances, hospital and community pharmacists can be the most accessible healthcare professionals and contribute to CVD prevention, early detection, treatment adherence and long-term care;

AG. whereas social determinants of health refer to the non-medical factors and systems that shape everyday life conditions and are defined as the circumstances in which people are born, grow up, live, work and age,;

AH. whereas social determinants of health, including marketing and unsubstantiated health claims, can undermine prevention policies and normalise harmful consumption; whereas addressing social determinants is essential to ensure coherence and effectiveness across the EU’s NCD strategies;

AI. whereas exposure to social determinants of health differs across socio-economic groups; whereas many unhealthy products are consumed by children and young people;

AJ. whereas effective population-level prevention requires structural policy action beyond individual behaviour change;

AK. whereas according to the Safe Hearts Plan, taxation has played an important role in reducing risk factors linked to citizens’ lifestyles and around 40 % of the decline in smoking in the EU in the past decade can be attributed to taxation;

AM. whereas the economic cost of smoking in Europe, including healthcare expenditures, productivity loss and premature mortality, exceeds EUR 300 billion annually; whereas prevention is more effective than any cure, as well as the most cost-effective long-term cardiovascular control strategy;

AN. whereas tobacco use remains the leading preventable cause of NCDs in the EU, further exacerbating health inequalities; whereas strong tobacco control policies represent a cornerstone of cardiovascular and cancer prevention, these diseases being the two leading causes of death in the EU;

AO. whereas even low-intensity or occasional smoking substantially increases cardiovascular risk, and the use of novel tobacco and nicotine products is also associated with increased cardiovascular mortality;

AP. whereas scientific evidence indicates that e-cigarettes are not risk-free and pose significant cardiovascular risks, including through mechanisms that increase the risk of thrombosis and atherosclerosis, notably due to nicotine exposure and the inhalation of toxic substances;

AQ. whereas the WHO does not recommend e-cigarettes as a smoking cessation tool, and evidence indicates that e-cigarette use is associated with increased uptake of conventional tobacco products, particularly among young people;

AR. whereas cardiovascular health is strongly influenced by environmental, social, commercial and economic factors beyond the health sector; whereas the systematic application of a Health in All Policies approach, together with a One Health perspective, is essential for effective CVD prevention;

AS. whereas obesity, diabetes, sedentary lifestyle and insufficient physical activity are major contributors to cardiovascular morbidity and mortality, and progress in reducing these risk factors has stalled or reversed in several Member States;

AT. whereas strong social connections and support from family, friends and communities have been shown to improve cardiovascular health outcomes, reducing the risk of cardiovascular events, supporting recovery and enhancing adherence to treatment, effects that cannot be replicated by artificial intelligence or digital interventions alone;

AU. whereas nearly 80 % of the cardiovascular burden is attributable to modifiable risk factors;

AV. whereas the exposome approach considers the totality of exposures, such as environmental, chemical, physical, biological, social and behavioural exposures across an individual’s lifetime and provides a unified framework for targeted prevention; whereas studies have shown a strong correlation between the exposome and cardiovascular health, with various components of the exposome having been implicated in the development and progression of CVD;

AW. whereas evidence indicates that community noise exposure above Lden 70 dB and Lnight 60 dB may impair behavioural and cognitive development in children and is associated with increased cardiovascular risk across the life course;

AX. whereas reducing the CVD burden requires action at multiple levels, including population-level measures to reduce exposure to risk factors, strengthened health literacy and improved competencies among health professionals and patients;

AY. whereas cardiovascular screening and follow-up screening are appropriate prevention solutions, to the extent that they are targeted on individuals presenting risk factors; whereas appropriate family screening should be provided where CVDs with genetic predisposition are detected;

AZ. whereas non-targeted or non-evidence-based cardiovascular screening and diagnostic practices may provide limited benefit while increasing overdiagnosis, overtreatment and inefficient use of healthcare resources, making the avoidance of low-value healthcare essential for patient safety and system sustainability;

BA. whereas regular physical activity is a key protective factor against CVDs and is particularly important for children and adolescents, as it lowers blood pressure, improves cholesterol levels, supports blood glucose regulation, helps maintain a healthy body weight and reduces systemic inflammation, establishing health behaviours that persist into adulthood;

BB. whereas diet and nutrition play a key role in preventing CVDs and poor diet and unhealthy habits are strongly associated with an elevated risk of CVDs morbidity and mortality; whereas cardiovascular health is influenced by the cumulative effects of dietary habits as they are shaped by food systems, social practices and patterns of availability, rather than by isolated dietary components; whereas approaches that abstract nutrition policy from this broader context risk oversimplifying the determinants of health and reducing the effectiveness of CVD prevention efforts;

BC. whereas a preventive health approach and the promotion of healthy habits play a fundamental role in addressing CVD and its risk factors;

BD. whereas food systems contribute to both human and planetary health;

BE. whereas ‘energy’ drinks may pose cardiovascular risks, especially to young people, due to high levels of caffeine and other stimulants, which can cause increased heart rate, elevated blood pressure and abnormal heart rhythms;

BF. whereas healthy diets have a positive impact on cardiovascular risk; whereas dietary patterns in many Member States are characterised by an excessive intake of salt, sugar and saturated fats; whereas balanced, healthy diets such as the traditional Mediterranean and Nordic diets, as well as plant-based diets and certain diets based on organic food are associated with significantly lower CVD risk;

BH. whereas the EU is a world leader in research, including in health research; whereas structural barriers in the EU regulatory environment have led to this leadership not being adequately matched by its capacity to translate research into practical therapies; whereas cardiovascular therapies accounted for only 4 % of clinical trials started between 2017-2022; whereas the EU’s scientific leadership should be harnessed to combat CVD; whereas the innovation capacity of the EU’s life science sector needs to be supported and facilitated;

BI. whereas the effective and equitable use of digital health tools, AI and innovative medical technologies depends on adequate digital literacy among patients, health professionals and the wider population;

BJ. whereas rising temperatures and more frequent heatwaves are expected to have increasingly severe impacts on cardiovascular health, particularly among older people and people with chronic conditions, rare diseases and disabilities; whereas heat-related mortality represents the largest share of climate-related deaths in Europe, with cardiovascular causes accounting for a substantial proportion, and whereas the interaction between extreme heat, drought and air pollution further exacerbates cardiovascular risk;

BK. whereas occurrences such as climate change, extreme weather events, air pollution, environmental degradation, chemical exposure, security challenges and other stress factors significantly contribute to CVD risk by increasing rates of heart attacks, arrhythmias and other cardiac events and are expected to continue to influence future cardiovascular health outcomes;

Areas of action

I. Prevention

1. Reiterates the need to systematically apply a Health in All Policies approach at EU and national level; calls for health aspects to be included in impact assessments for major EU legislative initiatives which are relevant to public health; recalls that accessible, timely, affordable and good-quality healthcare is a fundamental right and part of the right to health; stresses that effective and sustainable healthcare systems should ensure equitable access to cardiovascular prevention, diagnosis, treatment and rehabilitation for everyone, irrespective of their circumstances, such as gender, income, employment status, residence status or place of living; stresses that this represents one of the most effective strategies to prevent, detect and treat CVDs; calls for the Commission and the Member States to urgently address inequalities;

2. Emphasises that effective prevention of CVDs starts in early childhood and continues throughout life and requires early and sustained action; underlines that tackling obesity at a young age is essential to lowering the risk of developing cardiovascular conditions later in life;

3. Stresses that Europe’s response to CVDs must move decisively from a predominantly acute-care approach towards a prevention-oriented and integrated approach across the life course, encompassing primary, as well as secondary and tertiary prevention; calls on the Commission to adopt a horizontal EU health prevention plan to address all risk factors for NCDs; underlines that prevention should include congenital heart disease transition pathways, pregnancy-related cardiovascular risk monitoring and age-adapted strategies for older adults; calls for a coordinated prevention approach to CVDs and their interconnected risk factors and comorbidities, including all major NCDs, given their overlapping clinical pathways; underlines the need to raise awareness about comorbidities and strengthen risk assessments;

4. Underlines that according to scientific advice, investing in effective prevention lowers healthcare costs in the long run, lessens the burden on the healthcare workforce and contributes to preventing workforce shortages;

5. Stresses that high levels of health literacy and understanding of various risk factors are essential for reducing exposure to cardiovascular risk factors across the whole population and for improving patient engagement, self-management and adherence to treatment; calls on the Member States and the Commission to promote awareness campaigns in order to strengthen cardiovascular and health literacy across the life course, including early symptom recognition, basic life-saving skills and community-level response, recognising that empowered and informed populations are essential to reducing preventable cardiovascular deaths;