Changes from plenary report to adopted text

6. Encourages the Member States to put in place practical measures to support long-term adherence to treatment, including patient-centred treatment optimisation, coordinated follow-up by multidisciplinary teams and the use of validated digital tools (such as reminders and follow-up solutions);

7. Recognises that psychosocial factors and mental health conditions, including depression, chronic stress and anxiety, are increasingly relevant cardiovascular risk factors, particularly among adolescents and young adults; calls for rehabilitation policies to include psychosocial support across the life course;

8. Highlights the central role of primary care and community-based providers, including in advancing cardiovascular health literacy, with specific recognition of community pharmacists as often being among the most accessible healthcare professionals, especially in underserved regions, and hospital pharmacists in providing patient education, self-management support and adherence counselling through regular, low-threshold interactions with citizens;

9. Encourages the Member States to strengthen first aid education and rapid response capacity for medical emergencies through basic training, awareness-raising and the exchange of best practice at EU level;

10. Encourages the use of health promotion programmes, education, immunisation campaigns and labelling complemented by digital labelling and other digital tools to improve consumer information, empowerment and protection, supported by advice delivered through primary healthcare, including hospital and community pharmacies; considers that these measures should complement public health policies and a broader framework promoting healthier food environments, recognising that effective health prevention requires addressing wider socio-economic factors while empowering citizens to make informed choices;

11. Notes that viral infections, including respiratory infections, are associated with an increased cardiovascular risk; welcomes the announced Council recommendation on vaccination against respiratory infections as a preventive measure for CVDs and calls on the Commission to advance on it, in parallel with the development and implementation of national cardiovascular health plans and in consultation with national scientific experts and relevant stakeholders, in order to ensure the timely coordination, coherence and complementarity of action at the EU and national levels; highlights that the prevention of infectious diseases can contribute to reducing the risk of CVDs; stresses the importance of targeted vaccination programmes for populations at increased cardiovascular risk;

12. Calls on the Council to adopt Council recommendations on comprehensive, evidence-based health education in schools, including cardiovascular health literacy and awareness of metabolic, behavioural, environmental and other risk factors for CVD, healthy lifestyles, including the effect of physical activity, reduction of sedentary behaviour and healthy diets, and the prevention of NCDs; calls on the Member States to implement these recommendations and make health education a core component of their national cardiovascular health plans;

13. Underlines that social determinants of health, including the marketing of different products that contribute to the development of heart diseases and interconnected NCDs, can have a negative influence on consumer choices and therefore contribute to the development of CVDs; underlines that these practices can undermine public health objectives and have a disproportionate impact on lower-income households; reiterates the need for clear consumer information about the risk associated with the different categories of marketed products; emphasises that young people and children are particularly vulnerable and deserve specific and tailored protection from targeted advertising and marketing that are inappropriate for them; calls on the Member States to take appropriate measures to reduce children’s and adolescents’ exposure to the advertising of products which can contribute to the development of heart diseases and interconnected NCDs, including in the digital environment; calls on the Commission to address the regulatory gaps in the marketing of these products, including user content on social media platforms, websites, game platforms and apps, and to evaluate the Audiovisual Media Services Directive in that respect;

14. Stresses that health policy must be evidence-based, aligned with the best available scientific data and be free from undue influence; recognises that successful health policy and cardiovascular prevention require a whole-of-society approach; calls for transparency in decision-making processes and lobbying activities related to cardiovascular health; recalls the EU’s commitments under the relevant international treaties to safeguard public health policymaking from commercial and vested interests; recalls that the Commission and the Member States apply conflict of interest rules and calls on the Commission and the Member States to ensure the effective management of potential conflicts of interest in expert groups, advisory bodies and policymaking processes related to cardiovascular prevention and disease;

15. Stresses that false and misleading health claims presented without adequate context and unsupported by scientific evidence, on products such as foods, e-cigarettes and other novel and emerging nicotine and tobacco products, can influence consumer choices and the effectiveness of prevention policies; recalls that existing EU legislation regulates the use of health claims about food and drinks; calls on the Member States to consider further actions to protect consumers, particularly children; calls for an improved and evidence-based regulatory framework to ensure that any communication to consumers on products that could increase cardiovascular risk factors is based on independent scientific evidence, is subject to appropriate oversight by competent public authorities, and does not mislead consumers about cardiovascular and other health risks; notes the Commission’s intention to establish nutrient profiles, as a measure to eliminate misleading nutrition and health claims; calls, furthermore, for the full enforcement of the prohibition on the free distribution of tobacco products;

16. Calls for the forthcoming revision of the Unfair Commercial Practices Directive to move beyond the protection of consumers’ economic interests alone and explicitly incorporate the protection of consumers’ health, in order to effectively address commercial practices that undermine people’s health;

17. Recognises that CVDs can be work-related and work-aggravated, and that occupational exposure constitutes a preventable risk factor for cardiovascular morbidity and mortality in the EU; calls on the Commission and the Member States to improve occupational risk assessment frameworks for cardiovascular risks;

18. Stresses that effective cardiovascular prevention requires healthier social, economic and physical environments; calls for comprehensive public policies addressing nutrition, working conditions, work-life balance, transport, physical activity, education and environmental protection;

Modifiable risk factors

Tobacco and smoking

19. Emphasises the importance of strong, evidence-based and appropriate regulatory measures to reduce access to and the affordability, consumption and appeal of different smoking devices and nicotine and tobacco products, including novel and emerging nicotine and tobacco products; notes that such measures may include, where relevant, bans on flavours, which are particularly attractive to minors and non-smokers, and limits on nicotine content, as well as the appropriate and effective excise taxation of the various products; recalls that nicotine has been shown to increase cardiovascular risk;

20. Stresses the increase in uptake by non-smokers and women of novel and emerging nicotine products; highlights that minors remain particularly vulnerable to starting to use new nicotine products such as e-cigarettes, nicotine pouches and heated tobacco products, which often come in attractive flavours and packaging; stresses the need to strengthen preventive and educational measures and to prevent minors and adolescents from accessing tobacco and nicotine products, including through effective enforcement of the ban on sales to minors, and strengthened age checks at the point of sale, including uniform rules for digital sales; calls on the Member States, in this regard, to swiftly implement the EU digital identity wallet to prevent minors from purchasing age-restricted goods;

21. Stresses that smoking cessation strategies and policies must be strictly aligned with scientific evidence and shaped in line with the independent advice of the scientific community;

22. Stresses that nicotine consumption, in conventional, novel and emerging forms, can elevate blood pressure, increase the risk of arrhythmia and contribute to endothelial dysfunction and accelerated atherosclerosis; notes that nicotine content levels and delivery methods vary across products, and that different nicotine products may therefore have differentiated risk profiles, but that all such products still present health risks;

23. Calls for all non-medicinal nicotine products, including novel and emerging tobacco and nicotine products, to be included within the scope of the Tobacco Products Directive and to be subject to appropriate rules on age limits, flavourings, nicotine content, packaging and marketing, with the aim of ensuring legal certainty and strong safeguards, in particular for young people; stresses the need for clear, comprehensive and technology-neutral definitions; calls for better alignment with the principles of the WHO Framework Convention on Tobacco Control;

24. Calls for clear and effective regulation on the advertising, promotion and sponsorship of tobacco and nicotine products, including novel and emerging tobacco and nicotine products, across all media and communication channels, including online platforms and social media, and for the introduction of measures to eliminate indirect marketing practices and reduce product appeal, particularly towards minors, with due respect for national competencies; urges for social media advertising to be explicitly included and covered in the scope of the Tobacco Advertising and Sponsorship Directive;

25. Welcomes the Commission’s initiative to revise the legislative framework on tobacco control, first announced in Europe’s Beating Cancer Plan, which is, in synergy with the EU CVD strategy, critical to achieving agreed EU objectives on tobacco control policies; calls on the Commission to present a strong, science-based revised framework as soon as possible in order to reach the goal of a tobacco-free generation with less than 5 % of the population using tobacco by 2040, as set out in Europe’s Beating Cancer Plan; notes with concern that current smoking rates in Europe risk undermining this objective; stresses the need for future proposals to be supported by proper impact assessments, in line with the Better Regulation guidelines; recalls the growing awareness around reconsidering the effectiveness of cigarette filters, since they may provide a false perception of reduced harm;

26. Calls for the introduction of pre-market health impact assessments for all new tobacco and nicotine products, including heated tobacco products, e-cigarettes, and nicotine pouches, where appropriate and in accordance with EU law;

27. Calls on the Member States to effectively enforce smoke-free legislation covering all indoor public places and workplaces and to further introduce smoke-free legislation covering outdoor areas frequented by children, such as school grounds, in order to protect the population from exposure to second-hand smoke;

28. Recalls that the Commission implements rules on lobbying transparency that also apply to the tobacco industry, and that certain directorates-general have applied additional arrangements when interacting with representatives of this industry; notes that the European Ombudsman, in her decision on case OI/6/2021/KR on the transparency of the Commission’s interactions with representatives of the tobacco industry, made further recommendations to ensure transparency with regard to the WHO Framework Convention on Tobacco Control;

Harmful alcohol consumption, particularly at levels exceeding scientifically established health recommendations

29. Stresses that harmful alcohol consumption, particularly at levels exceeding scientifically established health recommendations, increases the risk of CVDs, cancer and other NCDs; underlines that it can cause a sustained increase in blood pressure, which is a major risk factor for heart attacks, strokes and other cardiovascular conditions, and is associated with an increase in both ischaemic and haemorrhagic stroke;

30. Calls on the Commission and the Member States to build on the comprehensive alcohol policy measures set out in Europe’s Beating Cancer Plan, including through a review of the Directive on the harmonization of the structures of excise duties on alcohol and alcoholic beverages; recalls that taxation is primarily a matter of national competence; notes that Member States may use a variety of policy measures as part of their alcohol policy, including fiscal measures, and underlines that levies, taxes and duties can serve as incentives to influence consumer behaviour;

31. Calls for awareness among consumers to be improved by providing them with better, accurate nutritional and health information on alcohol; notes the Commission’s proposal in Europe’s Beating Cancer Plan to introduce the mandatory indication of the list of ingredients and the nutrition declaration on labels of all alcoholic beverages;

32. Underlines the need to take a clear alcohol prevention approach and calls on the Member States to implement education and communication campaigns on the cardiovascular and other health risks associated with harmful alcohol consumption, particularly at levels exceeding scientifically established health recommendations; encourages the exchange of best practice between Member States, including on awareness-raising campaigns and appropriate support services, to reduce underage drinking and protect people from alcohol-related harm;

33. Calls for the effective regulation of alcohol advertising and sponsorship in contexts where it could reach minors;

Drugs

34. Is concerned about the rise of drug consumption in the EU, with new types of drugs being increasingly available; highlights the lack of awareness about the adverse effects that drug consumption and addiction have on the cardiovascular system; calls for the EU and the Member States to support and deploy awareness-raising campaigns on the dangerous effects of drugs and to better train health professionals on the complex patterns of polysubstance consumption; calls for the EU and the Member States to put in place ambitious cross-cutting policies to eliminate drug consumption in Europe;

35. Underlines the need to promote public awareness campaigns on the cumulative cardiovascular risk of the simultaneous use of harmful substances;

Unhealthy diets and physical inactivity

36. Stresses that unhealthy lifestyles and poor dietary habits contribute to the development of CVDs and other NCDs; highlights the importance of promoting balanced diets and physical activity;

37. Underlines that overweight and obesity are one of the major drivers of CVDs and are recognised risk factors for several cancers, and that dietary quality is a leading driver of cardiovascular health; highlights, therefore, the need for a comprehensive food system approach across all relevant EU policies, with a view to systematically reducing obesogenic food environments and promoting healthier dietary behaviours;

38. Calls for EU measures to improve the food environment, including front-of-pack nutrition labelling in line with nutritional recommendations and the regulation of marketing practices for unhealthy foods; welcomes voluntary industry commitments but underlines that they should be complemented by more consistent and enforceable legislation; stresses that such measures should avoid having unintended impacts on foods designed to meet specific nutritional needs and takes note of the specific characteristics of products protected under EU quality labels such as the protected designation of origin (PDO) or the protected geographical indication (PGI);

39. Calls for EU measures to improve consumer awareness and access to information on the relationship between diet and health, including through educational campaigns in schools; emphasises that the promotion of a nutritionally adequate, diverse and balanced dietary pattern, encompassing a broad spectrum of nutrient categories in appropriate quantities and taking into account the cultural diversity across the EU, is a cornerstone of effective public health policy; underlines that prevention strategies should support informed consumer choices and dietary habits grounded in robust scientific evidence; further supports the launch of initiatives that encourage the consumption of natural, fresh, seasonal and local foods, enhancing short supply chains and strengthening the links between agriculture and health; emphasises that farmers and their organisations should be involved in the delivery of such initiatives to foster connections between sustainable agriculture, nutrition and public health;

40. Calls on the Commission to ensure that the revision of the Public Procurement Directives enables public authorities to provide healthier meals, including foods produced locally and through sustainable practices; calls for the strategic use of public food procurement to improve equitable access to healthy meals in childcare facilities, schools, hospitals and other public institutions; welcomes the Joint Research Centre’s technical guidance on promoting healthier options in public procurement and encourages its application by national, regional and local authorities;

41. Calls for stronger coherence between EU health objectives and EU agri-food policies to ensure that public funding supports the production and consumption of foods associated with reduced cardiovascular risk;

42. Stresses that effective prevention of CVDs, and other chronic diseases must begin early in life and follow a life-course approach; highlights the alarming rise in childhood obesity and unhealthy dietary patterns; calls for the continuation and sufficient financing of the EU school scheme for milk, fruit and vegetables; calls for healthy and accessible school meals and the introduction of minimum quality standards for school and public canteens; calls for the availability of fresh, natural and seasonal produce for these canteens to be ensured, while reducing their reliance on foods high in fat, sugar and salt; further calls for public authorities to promote and fund healthy dietary habits in all circumstances and from an early age, including sporting facilities and recreational areas;

43. Highlights that marketing practices for foods high in fat, sugar and salt may play a role in shaping children’s dietary habits and therefore contribute to the onset of childhood obesity and other lifelong chronic diseases; stresses in particular the need to improve the regulation of the marketing and advertising of such products to children and adolescents across all channels, including online platforms, social media and influencer marketing and with respect to algorithmic targeting and emerging AI-enabled marketing practices; highlights the existing EU legislation in this area and welcomes ongoing initiatives, including the revision of the Audiovisual Media Services Directive, as announced in the Safe Hearts Plan, and the implementation of the Digital Services Act;

44. Highlights that current diets in the EU are not in line with nutritional recommendations, with only 12 % of Europeans consuming five or more portions of fruit and vegetables daily; whereas balanced healthy diets such as traditional European dietary patterns, including the Mediterranean and Nordic diets, as well as plant-based diets and certain diets based on organic food, are associated with significantly lower CVD risk; emphasises the importance of the daily consumption of fruits and vegetables and a reasonable consumption of red and processed meat in line with European public health recommendations; notes that fruit and vegetable consumption in forms that preserve fibre and nutritional value can support a healthy and balanced diet;

45. Underlines that there are a variety of barriers to healthy dietary choices; emphasises in particular that cross-sectoral action is necessary to create food environments where healthier foods are the easiest and most affordable choice for EU citizens, since healthier diets tend to be more expensive than less healthy ones and pricing disproportionately affects low- and middle-income segments of the population; emphasises the need to address obstacles in access to healthy and nutritious food; calls for adequate strategies that make healthier products more affordable; invites the Member States to improve the affordability and accessibility of fruits, vegetables, legumes and whole grains, including through targeted regulatory measures and by making full use of EU funding instruments;

46. Stresses that private operators should strive to enhance the nutritional quality of the products they offer for the health of consumers;

47. Welcomes the fact that the Safe Hearts Plan mentions an ongoing Commission study on the impact of the consumption of ‘ultra-processed foods’; calls on the Commission to develop and promote a clear, science-based and harmonised definition of ‘ultra-processed foods’ at EU level, with an exception for foods formulated to meet specific nutritional requirements arising from diagnosed medical conditions, allergies, severe intolerances or other pathologies, in order to support coherent nutrition policies, and strengthen evidence-based action to prevent cardiovascular and other NCDs;

48. Acknowledges that traditional processing techniques, such as fermentation, canning, drying and salting, have played an important role in ensuring food preservation, thereby enhancing health and safety standards and, in many cases, improving availability of agricultural products for healthier diets;

49. Calls on the Commission to assess the cardiovascular health impacts of ‘energy’ drinks and to subsequently support appropriate EU-level measures, where motivated by the assessment and scientific evidence, in particular to protect children and adolescents; calls on the Commission, where motivated by the assessment and scientific evidence, to also subsequently support and encourage Member States to consider measures regarding the availability of energy drinks in settings primarily used by minors, and supports the exchange of best practice at EU level;

50. Emphasises the importance of integrated urban and transport interventions aimed at reducing obesogenic environments, improving access to active mobility, and embedding health objectives across spatial planning, housing and infrastructure policies; highlights that urban planning, including through the provision of ample pedestrian and green spaces and safe conditions for walking and cycling, contributes directly to preventing heart diseases; calls for public investment in healthy urban environments that promote physical activity, improve air quality and reduce cardiovascular risk; calls for enhanced cross-sectoral cooperation to create supportive environments and aligned policies that encourage physical activity throughout the life course, contributing to both the prevention of CVD and effective rehabilitation;

51. Calls on the Member States to take targeted measures to promote healthier daily habits among children and young people by increasing opportunities for physical activity and reducing sedentary behaviour, as these actions help prevent key modifiable risk factors for CVDs such as physical inactivity, overweight and obesity; further stresses that education and access to reliable information on physical activity are crucial for people of all ages; calls on the Commission and the Member States to promote initiatives such as sports activities for seniors in local communities and accessible sports classes and to make sure that school curricula allow sufficient time for moving each day, in order to create an environment conducive to a healthy lifestyle;

52. Calls on the Commission and the Member States to engage the sports sector as a key setting for promoting physical activity and healthy behaviours, including through grassroots sports initiatives and by avoiding the marketing of foods high in fat, sugar and salt at sports events;

Socio-economic determinants of health

53. Stresses that cardiovascular health is also a social issue of public concern and that the persistence of CVDs across the EU, including the contributing risk factors of diabetes and obesity, are closely linked to socio-economic determinants such as income inequality, insecure employment, housing conditions, education level, gender and environmental exposure; recalls that these determinants disproportionately affect low-income households, people with chronic, rare diseases and disabilities, workers in precarious employment, women, older persons, children and young people, and marginalised communities, generating cumulative, lifelong cardiovascular risks; calls for cardiovascular health policies to be firmly embedded within the EU’s broader social, cohesion and inclusion policies and to ensure that those who are most at risk are sufficiently taken into account;

54. Stresses the need to address the socio-economic determinants of cardiovascular health at both national and EU level through the effective implementation of current EU frameworks;

55. Welcomes the Safe Hearts Plan and insists that any EU cardiovascular strategy must be integrated into the EU’s social, environmental and economic policies; emphasises that poverty and job insecurity significantly increase exposure to cardiovascular risk factors, including chronic stress, unhealthy diets, physical inactivity, inadequate housing and limited access to preventive care;

56. Stresses that health policy should involve the perspectives of patients and informal carers to ensure that decision-making reflects their lived experiences and results in policies that meaningfully improve their daily lives and long-term well-being;

Environmental determinants of health

57. Stresses that environmental determinants, including air pollution, noise pollution, pollution of soil and water, extreme temperatures and chemical exposure, in particular of populations who come in close contact with pesticides in their work or in their communities, are major preventable contributors to CVDs in the EU; highlights that these determinants are unevenly geographically distributed across and within Member States; highlights that heatwaves and other climate-related extreme events disproportionately affect older persons and people living in poorly insulated housing, thereby exacerbating cardiovascular risks and social inequalities; regrets that the Commission has not sufficiently recognised that reducing exposure to harmful environmental factors must be made a core pillar of any effective EU cardiovascular health plan and requires coordinated, cross-sectoral action beyond the health sector; emphasises that the prevention of CVD should be embedded in a One Health approach, recognising the interconnections between human, animal and environmental health;

58. Underlines that contrary to changes in lifestyle, people cannot protect their health against air or chemical pollution; calls on the Commission to put forward tangible action on these health determinants that falls within the EU’s competences;