Changes from report parliamentary committee draft to plenary report

Added36. 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;

Removed16. Highlights that car-dependent urban planning, lack of green spaces and unsafe conditions for walking and cycling contribute directly to heart diseases; calls for public investment in healthy urban environments that promote physical activity and reduce cardiovascular risk;

Added37. 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;

Added38. 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);

Added39. 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;

Added40. 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;

Added41. 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;

Added42. 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;

Added43. 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;

Added44. 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;

Added45. 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;

Added46. Stresses that private operators should strive to enhance the nutritional quality of the products they offer for the health of consumers;

Added47. 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;

Added48. 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;

Added49. 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;

Added50. 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;

Added51. 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;

Added52. 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

Change 8

Changed17.53. Stresses that cardiovascular health is also a social andissue politicalof issuepublic concern and that the persistence of cardiovascular diseaseCVDs across the EUEU, isincluding the contributing risk factors of diabetes and obesity, are closely linked to socio-economic determinants such as income inequality, insecure employment, housing conditions, education levellevel, 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 personspersons, children and young people, and marginalised communities;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;policies and to ensure that those who are most at risk are sufficiently taken into account;

Change 9

Changed18.54. Stresses the need to address the socio-economic determinants of cardiovascular health at both national and EU level; callslevel forthrough the effective useimplementation of current EU frameworks, including the European Pillar of Social Rights Action Plan and the EU Anti-Poverty Strategy;frameworks;

Change 10

Added55. 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;

Added56. 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

Change 11

Changed19.57. Stresses that environmental determinants, including air andpollution, noise pollution, chemicalpollution exposureof soil and water, extreme temperatures,temperatures and chemical exposure, in particular of populations who come in close contact with pesticides in their work or in their communities, are major and preventable contributors to cardiovascular diseaseCVDs 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;

Change 12

Removed20. Recognises long-term exposure to environmental noise from road, rail and air traffic as a significant but under-addressed cardiovascular risk factor; calls for strengthened noise reduction policies through urban planning, transport regulation and enforcement of current EU legislation;

Added58. 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;

Added59. Recognises long-term exposure to environmental noise from road, rail and air traffic as a significant but under-addressed cardiovascular risk factor; calls for strengthened noise reduction policies in order to reduce harmful noise levels and protect health and well-being across the EU through urban planning, transport regulation and enforcement of current EU legislation; underlines that sufficient funding of nature-based solutions, which can have a positive impact on health, should be considered as part of the One Health perspective;

Added60. Calls on the Commission and the Member States to address the significant health risks arising from air, soil and water pollution; highlights that methane and ammonia are contributors to harmful air pollution, which is associated with reduced lung function, systemic inflammation and increased cardiovascular morbidity and mortality;

II. Early detection and diagnosis

Change 13

Removed21. Welcomes the announced Council recommendation on cardiovascular health checks; stresses that any EU guidance must be evidence-based, respect Member State competence, reduce inequalities and avoid low-value practices;

Added61. Welcomes the announced Council recommendation on health checks for cardiovascular diseases; stresses that any EU guidance must be evidence-based, effective, focused on the needs of patients, healthcare professionals and carers and the problems they face, and accompanied by clear benchmarks and indicators, and must reduce inequalities and avoid low-value practices; notes that this guidance should be risk-stratified and include integrated referral pathways from primary care to follow-up secondary care for CVD and its comorbidities; highlights, furthermore, that such guidance must include recommendations on implementation, including active cross-border cooperation and quality assurance dispositions, to ensure effective coverage of at-risk populations; calls for the implementation in the Member States of the announced Council recommendation on health checks for cardiovascular diseases, while respecting their competences and emphasises the importance of promoting education and training for healthcare professionals on the early detection of CVD, with appropriate consideration of gender-specific differences;

Removed22. Stresses that early detection should prioritise targeted, risk-based approaches in primary care, focusing on major conditions and CVD risk factors such as tobacco and alcohol use, obesity, hypertension, diabetes, kidney disease, dyslipidemia, coronary disease, atrial fibrillation, heart failure and structural abnormalities, while ensuring effective referral and long-term follow-up pathways;

Added62. Calls on the Commission to ensure adequate financial support for Member States for the implementation of the Council recommendation on health checks for cardiovascular diseases; stresses that this financial support should be appropriate for and proportional to the scale of the burden of CVDs;

Removed23. Stresses that dyslipidemia such as familial hypercholesterolemia contributes substantially to cardiovascular risk; emphasises the importance of implementing lipid screening for all school children;

Added63. Believes that early detection of CVDs should be pursued through an integrated, cross-disease approach that recognises interlinkages between cardiovascular and other NCDs and their shared risk factors; points out that such broad prevention and early detection strategies addressing CVDs and other NCDs can empower patients to better understand and manage their health and can help to prevent premature mortality;

Removed24. Recommends that individuals with at least one risk factor should undergo a cardiovascular-renal-metabolic health check at primary care level before the age of 35; recommends that individuals with elevated or abnormal findings should undergo systematic monitoring and follow-up;

Added64. Is concerned about the number of misdiagnosed cardiovascular events and calls on the Member States to better train health professionals on possible symptoms, including in emergency services; underlines the importance of national healthcare systems introducing standardised protocols to better detect cardiovascular events; highlights the need for regional and local health infrastructures and hospitals to provide specialised services for cardiovascular events and to ensure that patients can get swift access to such services in order to prevent misdiagnosis and ensure adequate treatment;

Added65. Stresses that early prevention and detection should prioritise targeted, risk-based approaches supported by validated risk prediction models in primary care, including through screening where appropriate; emphasises the need to focus on risk factors such as tobacco consumption, harmful alcohol consumption, particularly at levels exceeding scientifically established health recommendations, obesity, insufficient physical activity, hypertension, menopause, family history and dyslipidaemia; underlines that individuals living with conditions such as chronic kidney disease, diabetes, obesity, chronic obstructive pulmonary disease, metabolic dysfunction-associated steatotic liver disease and chronic anaemia, as well as women with adverse pregnancy outcomes, should be systematically screened for CVD, while ensuring effective referral systems and long-term follow-up pathways; highlights that CVDs are often detected only after major events such as heart attack or stroke;

Added66. Underlines that early detection is often missed, especially in underserved and high-risk populations; calls on the Member States to ensure equitable access to diagnostics, paying particular attention to underserved areas and to women;

Added67. Underlines the essential role of secondary prevention for individuals who have experienced a cardiovascular event, including systematic risk-factor management, medication adherence, lifestyle and mental well-being support and regular clinical review to reduce the risk of recurrence;

Added68. Draws attention to the substantial underdiagnosis of inherited, genetic and congenital cardiovascular conditions in the EU, including cardiomyopathies, channelopathies, familial hypercholesterolaemia, type 1 diabetes, aortopathies, connective tissue disorders and congenital heart disease; stresses that dyslipidemias such as familial hypercholesterolemia, elevated lipoprotein (a) and hyperglycaemia contribute substantially to cardiovascular risk; calls on the Member States to ensure equitable access to diagnostics and to support early detection of genetic conditions from the school age of children, where there is clear scientific evidence of clinical benefit, while fully respecting ethical principles, informed consent and data protection requirements; stresses that when CVDs with a genetic predisposition are detected, family/cascade screening should be provided;

Added69. Calls for the announced Council recommendation on health checks for CVDs to include clear guidance on comprehensive cardiovascular risk assessments and on providing health checks at an appropriate age to individuals with at least one risk factor, including those with a family history of premature CVD; also calls for clear guidance on systematic monitoring and follow-up of individuals with elevated or abnormal findings, including integrated pathways to care;

Added70. Stresses that persons with multiple modifiable cardiovascular risk factors should be offered comprehensive and accessible support to change their lifestyle behaviours with the assistance of appropriately trained lifestyle medicine specialists or equivalent healthcare professionals;

III. Treatment, care and rehabilitation

Change 14

Changed25.71. Underlines that people living with cardiovascular diseaseCVD must have timely and affordable access to high-quality, integrated, evidence-based and guideline-based care acrossalong the full disease care pathway;pathway, including to treatment control and adherence support, as well as appropriate diagnostics and therapies, irrespective of place of residence; recommends a possible cautious use of treat-to-target management frameworks, while avoiding low-value care and ensuring a person-centred, risk-based approach in line with WHO guidance; stresses that cardiac rehabilitation, occupational rehabilitation, integrated nutritional care, physical rehabilitation and social reintegration are integral components of effective cardiovascular care; notes that, in several Member States, access to rehabilitation services remains limited and emphasises the need to guarantee access to these services to all; stresses the need for dedicated age-appropriate rehabilitation centres;

Change 15

Removed26. Stresses the growing threat of health workforce shortages; calls for improved working conditions, training, retention and multidisciplinary team-based care, with strong primary care as the backbone;

Added72. Welcomes the announced Council recommendation on personalised treatment and monitoring of cardiovascular diseases, which will improve the quality and consistency of personalised and integrated care pathways;

Removed27. Underlines the importance of ensuring timely and equitable access to palliative care for people living with advanced cardiovascular disease; calls for adequate training of healthcare professionals in palliative care principles in order to promote dignity, quality of life and people-centred care throughout the life course;

Added73. Calls on the Member States to create comprehensive, standardised national cardiovascular care protocols for long-term care pathways, embedding multi-disease, multidisciplinary team models to enable proactive management of interconnected NCDs, ensure smooth care transitions and deliver truly patient-centred care throughout the continuum of cardiovascular risk, diagnosis, treatment and rehabilitation; stresses that such pathways are essential to ensure continuity of care, reduce avoidable complications and hospital readmissions, and improve long-term outcomes for people living with CVD; stresses the need for more streamlined care pathways for reproductive and maternal health and CVD services; calls for the Member States and local and regional authorities to be supported in expanding access to multidisciplinary rehabilitation services;

Change 16

Changed28.74. Stresses that cardiovascularthe diseasesneed causefor substantialcare disabilityand affectingtreatment patients’to workincorporate andthe qualitylatest ofscientific life;evidence; calls on the Member States to deviseincorporate carehigh-quality, strategiesinnovative addressingtreatments workplaceinto reintegrationhealthcare measuresstrategies and psychosocialto support;make such treatments more accessible;

Change 17

Added75. Calls on the Commission and the Member States to support wider deployment of and access to cardiopulmonary resuscitation (CPR) training and public awareness programmes, including for children and young people, as an essential component of strengthening CVD emergency preparedness and response; calls for strengthened EU support to improve survival following out-of-hospital cardiac arrest, including mandatory CPR and automated external defibrillator (AED) training in schools and workplaces; calls on the Member States to strengthen policies ensuring wide, visible and 24/7 accessible deployment of AEDs in public spaces and high-traffic settings and calls for the development of national AED mapping and maintenance systems and for the integration of AED location data into emergency dispatch systems;

Added76. Calls for the strengthening of the cross-border European transplant information system, especially for rare and congenital CVDs;

Added77. Calls for the creation of a European network of cardiovascular centres of excellence, including stroke and heart units, as specialised, multidisciplinary institutions, operating under the Cross-Border Healthcare Directive; stresses that these centres should act as national and regional hubs to improve access to high-quality, multidisciplinary care, reduce time to treatment and strengthen hospital capacity; emphasises their potential role in promoting common standards and best practices, facilitating access to clinical trials and optimising clinical development; highlights their potential contribution to implementing comprehensive, patient-centred care pathways and allowing for the translation of research into practice through multi-stakeholder collaboration, including public-private partnerships;

Added78. Emphasises the importance of integrating mental health support as a component of comprehensive physical and psychological rehabilitation for patients living with chronic cardiovascular conditions and for those recovering from serious cardiovascular events;

Added79. Emphasises that uninterrupted access to safe, effective and affordable medicines and medical devices for CVDs is a prerequisite for continuity of care and favourable health outcomes; stresses that unequal access to essential cardiovascular medicines remains a major barrier to effective treatment and secondary prevention; calls for EU-level action, within the EU’s existing competences, to support affordability, availability and security of supply and underlines the importance of the forthcoming Critical Medicines Act in contributing to addressing those issues;

Added80. Stresses that delayed or absent treatment of structural heart disease significantly impairs quality of life and accelerates functional decline, frailty and loss of independence in older people; underlines that timely diagnosis and access to appropriate treatment are essential to preserve autonomy, reduce avoidable hospitalisations and support healthy and active ageing;

Added81. Stresses the growing threat of health workforce shortages in the Member States and underlines that the uneven distribution of general practitioners (GPs), especially in rural and disadvantaged areas, limits access to prevention and early detection of CVDs; calls for actions to improve the attractiveness of healthcare careers, which could include improved working conditions, adequate wages, training, retention measures and multidisciplinary team-based care, with strong primary care as the backbone; highlights the importance of technology and digital tools in enhancing efficiency, by reducing workload pressures and administrative burdens, and in increasing the attractiveness of healthcare careers; calls on the Commission and the Member States to enhance support mechanisms to improve retention and reverse mobility trends of cardiovascular medical personnel in areas affected by chronic shortages, including through targeted incentives and investments in working conditions, continuous training and attractive career pathways;

Added82. Underlines the importance of ensuring timely and equitable access to palliative care for people living with advanced CVD; calls for adequate training of healthcare professionals in the principles of palliative care in order to promote dignity, quality of life, and people-centred and gender-sensitive care throughout the life course;

Added83. Stresses that CVDs cause substantial disability affecting the work and quality of life of patients and their informal carers, as well as the ability of patients to live independently; calls on the Member States to devise care strategies addressing workplace reintegration measures and psychosocial and peer support for patients and their families;