Cardiovascular disease (CVD) causes over 1.8 million deaths in the European Union (EU) each year, accounting for 37% of all deaths at an estimated cost of €210 billion. CVD is one of the leading causes of premature death and disability in Ireland, accounting for 8,753 deaths (26.5% of all deaths) in 2021, of which 1,423 were due to stroke. Mortality rates from CVD (both ischaemic heart disease and stroke) have declined significantly in Ireland as in other high-income countries since the 1980s. This decline in one of the major causes of death has been the major driver of improvements in overall life expectancy during this period. These favourable trends in CVD mortality in all age groups reflect improvement in both underlying risk factors driving incidence (mainly smoking and diet) and the impact of evidence-based medical and surgical treatments.

However, despite these welcome declines in mortality, the absolute number of cases of CVD has increased in Ireland with our rising and ageing population and improved survival. It is also noteworthy that a significant slowdown in CVD-mortality decline is now apparent across high-income countries (including Ireland). This is linked to high and increasing obesity levels, diminishing, albeit still critically important, returns from tobacco control policies and persistent social inequalities in exposure to CVD risk factors and access to care. Recent trends in CVD mortality from the US are of particular concern in this regard. There is emerging evidence that the slowdown in the CVD-mortality decline was the major factor contributing to the stalling and subsequent reversal in life expectancy at birth observed in the US between 2010 and 2017, outpacing and overshadowing the effects of all other causes of death. 

In Ireland, the discourse on health is dominated by intervention strategies in high-risk individuals. The rhetoric on prevention inevitably falls short of the reality in terms of national policy priorities and resource allocation. In particular, the scope and potential of populationbased prevention strategies to address the distribution of CVD risk across the entire population, thereby reducing the incidence of CVD, have not been adequately addressed. In this policy paper we highlight the extent to which ‘upstream’ policy-based CVD prevention strategies are more effective, equitable and cost efficient than ‘downstream’ preventive activities targeting individuals. We outline a series of recommendations for implementing effective CVD primary prevention strategies and programmes in Ireland, drawing on international experience and best practice. Insofar as possible, the recommendations are set within the context of the Healthy Ireland Framework, Sláintecare, other relevant policies, including the Climate Action and Low Carbon Development Act, 2021, and ongoing prevention programmes and initiatives.