Changes from report parliamentary committee draft to plenary report

AddedF. whereas only a limited number of Member States met the global target of a 25 % reduction in the prevalence of high blood pressure by 2025, demonstrating insufficient progress in the prevention and management of one of the most significant and modifiable cardiovascular risk factors; whereas hypertension affects approximately 22 % of the EU population aged 15 and above and represents one of the most common risk factors for CVD; whereas inadequate detection and poor management of high blood pressure continue to be a cause of avoidable illness and premature deaths from cardiovascular causes across the EU;

RemovedG. whereas most CVD deaths are preventable and largely attributable to modifiable risk factors;

AddedG. whereas standardised death rates from diseases of the circulatory system continue to show stark regional disparities across the EU, reflecting a persistent east-west divide; whereas these gaps point to unequal exposure to risk factors and unequal access to timely prevention, diagnosis and quality care across regions; whereas only 11 out of 27 Member States have national cardiovascular plans; whereas there is a need for a common European approach to harmonise these plans to exchange information and for the Member States with no such plans to adopt the Safe Hearts Plan;

RemovedH. whereas strong primary care, effective prevention and risk-based early detection are essential for reducing avoidable deaths and disability;

AddedH. whereas demographic ageing, combined with the increasing prevalence of cardiovascular risk factors, is projected to further increase the burden of CVDs and related chronic diseases in the absence of integrated and strengthened prevention, early detection and healthcare system responses, while putting extra pressure on the healthcare workforce; whereas CVD affects all age groups, with early-life exposure to risk factors and delayed recognition in children, adolescents and young adults shaping lifelong outcomes; whereas a lifelong approach to cardiovascular health is therefore essential;

RemovedI. whereas commercial determinants of health, including marketing and misleading claims, can undermine prevention policies and normalise harmful consumption;

AddedI. whereas CVDs are closely linked with other major NCDs, including diabetes, hypertension, cancer, chronic kidney disease, obesity and many others; whereas a substantial share of cardiovascular conditions arise as complications of diabetes and related disorders that remain undetected, are diagnosed at a late stage, or are inadequately managed; whereas once CVD develops, managing diabetes becomes more complex and costly;

RemovedJ. whereas in 2021 tobacco use was responsible for more than 152 000 cardiovascular deaths and over 3.4 million disability-adjusted life years lost in the EU, with a disproportionate burden among men and socio-economically disadvantaged populations;

AddedJ. whereas diabetes affects approximately 34 million people across the EU, and whereas around one third of people living with diabetes will develop CVD in their lifetime, making diabetes a major, preventable driver of cardiovascular morbidity and mortality in Europe; whereas people living with type 1 diabetes, a lifelong autoimmune disease often diagnosed in childhood, face a substantially increased lifetime risk of CVD despite the absence of modifiable behavioural causes; whereas up to 40 % of children are diagnosed following diabetic ketoacidosis, a potentially life-threatening condition;

RemovedK. 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 cardiovascular disease prevention;

AddedK. whereas childhood overweight and obesity remain a major concern in Europe; whereas one in ten children aged 5 to 19 are obese and 25 % are overweight;

AddedL. 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;

AddedM. 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;

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

Addedin the EU;

AddedO. 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;

AddedP. 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;

AddedQ. 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;

AddedR. 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;

AddedS. 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;

AddedT. 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;

AddedU. 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;

AddedV. 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;

AddedW. 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;

AddedX. 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;

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

AddedZ. 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;

AddedAA. 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;

AddedAB. 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;

AddedAC. 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;

AddedAD. 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;

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

AddedAF. 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;

AddedAG. 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,;

AddedAH. 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;

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

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

AddedAK. 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;

AddedAL. whereas nicotine is an addictive cardiovascular toxin, and its use poses serious health dangers; whereas tobacco use, including active smoking, second-hand smoke exposure and new nicotine products, remains a major risk factor for CVD in the EU and significantly increases the risk of ischaemic heart disease, stroke, aortic aneurysm and peripheral arterial disease; whereas in 2023, tobacco use was responsible for approximately 160 000 cardiovascular deaths and over 3.27 million disability-adjusted life years lost in the EU, with a disproportionate burden among men and socio-economically disadvantaged populations;

AddedAM. 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;

AddedAN. 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;

AddedAO. 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;

AddedAP. 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;

AddedAQ. 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;

AddedAR. 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;

AddedAS. 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;

AddedAT. 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;

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

AddedAV. 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;

AddedAW. 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;

AddedAX. 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;

AddedAY. 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;

AddedAZ. 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;

AddedBA. 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;

AddedBB. 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;

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

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

AddedBE. 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;

AddedBF. 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;

AddedBG. whereas only 12 % of Europeans eat five portions or more of fruit and vegetables daily; whereas this share is lower among lower-income groups (10.8 %) than among higher-income groups (14.8 %), indicating a social gradient in access to and affordability of healthy diets; whereas independent scientific reviews have concluded that dietary patterns rich in vegetables, fruit, whole grains, berries, pulses, fish and a reasonable consumption of red and processed meats, added sugars, excess salt and processed foods are associated with lower risks of CVD, type 2 diabetes and premature mortality;