Changes from report parliamentary committee draft to plenary report

AddedBH. 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;

AddedBI. 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;

AddedBJ. 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;

AddedBK. 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

Change 2

Removed1. Reiterates the need to systematically apply a Health in All Policies approach at EU and national level; calls for mandatory health impact assessments for major EU legislative initiatives;

Added1. 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;

Removed2. Stresses that Europe’s response to cardiovascular diseases must move decisively from a predominantly acute care approach towards a prevention-oriented approach across the life course;

Added2. 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;

Removed3. Stresses that high levels of health literacy are essential for reducing exposure to cardiovascular risk factors and for improving patient engagement, self-management and adherence to treatment;

Added3. 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;

Removed4. Encourages the use of health promotion programmes, education, labelling and digital tools to improve consumer empowerment and protection, supported by advice delivered through primary healthcare;

Added4. 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;

Removed5. Calls on the Council to adopt Council recommendations on comprehensive, evidence-based health education in schools, including cardiovascular health literacy, healthy lifestyles and 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;

Added5. 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;

Removed6. Stresses that commercial determinants of health, including the aggressive marketing of tobacco, alcohol, ultra-processed foods and sugary drinks, play a decisive role in the development of heart diseases; underlines that corporate profit-driven practices often undermine public health objectives and disproportionately harm lower-income households;

Added6. 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);

Removed7. Stresses that health policy must be free from undue corporate influence; calls for transparency in decision-making and lobbying related to cardiovascular health;

Added7. 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;

Removed8. Stresses that false and misleading health claims, including claims suggesting cardiovascular or other health benefits of unhealthy products, constitute a major commercial determinant of cardiovascular disease risk; calls for strong EU action to prohibit such claims across all product categories, including tobacco and nicotine products, alcoholic beverages and ultra-processed foods, in order to protect consumers and prevent the normalisation of harmful consumption patterns; calls for strict EU action to prohibit or tightly regulate such claims, ensuring that any communication to consumers is based on independent scientific evidence, subject to prior authorisation by competent public authorities, and does not mislead consumers regarding cardiovascular and other health risks;

Added8. 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;

Added9. 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;

Added10. 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;

Added11. 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;

Added12. 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;

Added13. 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;

Added14. 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;

Added15. 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;

Change 3

Added17. 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;

Added18. 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

Change 4

ChangedTobacco and smoking

Change 5

Changed10.19. Emphasises the importance of strongstrong, evidence-based and appropriate regulatory measures to reduce access to and the affordability, appealconsumption and harmfulnessappeal of tobaccodifferent smoking devices and nicotine products, heatedand tobacco products, e-cigarettesincluding novel and emerging nicotine pouches,and includingtobacco throughproducts; flavournotes bans,that such measures may include, where relevant, bans on flavours, which are particularly attractive to minors and non-smokers, and limits on nicotine concentrationcontent, as well as the appropriate and effective excise taxation;taxation of the various products; recalls that nicotine has been shown to increase cardiovascular risk;

Change 6

Removed11. Calls for all non-medicinal nicotine products, including nicotine pouches, smokeless tobacco and e-cigarettes, to be fully included within the scope of the Tobacco Products Directive, and to be subject to the same rules on age limits, flavourings, nicotine content, packaging and marketing as other tobacco products;

Added20. 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;

Removed12. Welcomes the Commission’s initiative to revise the legislative framework on tobacco control, first announced in Europe’s Beating Cancer Plan; expresses concern about the continued delay in the revision of this legislation and calls on the Commission to present the revised framework without further delay;

Added21. 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;

RemovedHarmful use of alcohol

Added22. 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;

Removed13. Calls on the Member States to strengthen alcohol excise taxation, including through regular inflation adjustment and minimum tax levels, in order to reduce affordability;

Added23. 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;

Removed14. Calls for the introduction of mandatory, standardised and clearly visible health warning labels on alcoholic beverages, including warnings on cardiovascular risks associated with alcohol consumption, in order to improve consumer awareness and counter misleading perceptions of alcohol as a harmless or beneficial product;

Added24. 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;

Added25. 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;

Added26. 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;

Added27. 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;

Added28. 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;

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

Added29. 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;

Added30. 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;

Added31. 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;

Added32. 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;

Added33. Calls for the effective regulation of alcohol advertising and sponsorship in contexts where it could reach minors;

AddedDrugs

Added34. 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;

Added35. 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

Change 7

Removed15. Calls for binding EU measures to improve the food environment, including mandatory front-of-pack nutrition labelling, legally binding reformulation targets for salt, sugar and saturated fats, and restrictions on the marketing of unhealthy foods; stresses that voluntary industry commitments have proven insufficient and must be replaced by enforceable regulation;