Over the past 50 years, the development and implementation of preventive public health strategies, and medical advances in managing and treating cardiovascular disease (CVD), have resulted in significant declines in CVD morbidity and mortality. However, improvements have slowed in recent years, and in some countries, progress is now reversing. Today, CVD remains one of the most significant health concerns confronting European Union (EU) countries, and beyond. CVD remains the leading cause of morbidity and mortality in the EU, accounting for one‑in-three of all deaths (1.7 million deaths in 2022) and affecting an estimated 62 million people.

EU countries differ vastly in the magnitude of cardiovascular mortality, with Central and Eastern European countries having higher mortality rates compared to Western and Southern European countries. Regional inequalities in CVD mortality across the EU have been further exacerbated by COVID‑19. Countries with high pre‑pandemic CVD mortality, such as Bulgaria, Romania, Latvia and Lithuania, saw increases in age‑standardised mortality rates between 2019 and 2021, while those with lower mortality experienced smaller rises or continued declines, with Luxembourg and Portugal observing the greatest declines.

In most EU countries, the mortality rate from circulatory diseases is about 26‑60% higher in men than in women. Premature mortality (under age 65) is over three times higher in men. Regardless of geography or gender, people living with CVD report lower quality of life than their peers without CVD, including reduced well-being, poorer physical health, and worse mental health. These disparities reflect real gaps in access, quality, and system performance.

Aside from the human costs, CVD accounts for a significant share of healthcare expenditures in the EU. As of 2021, the total economic burden of CVD in the EU has been estimated at EUR 282 billion annually, amounting to approximately 2% of the region’s gross domestic product. This substantial financial commitment is distributed across several key components: direct healthcare costs, social care costs, informal care, and productivity losses. On a per capita basis, CVD-related costs averaged EUR 630 per EU citizen. The combined burden of healthcare expenditures and informal care costs is significantly greater for CVD than for cancer in the EU, sometimes even doubling them, highlighting the considerable burden on people living with CVD, as well as their families and caregivers.

All EU countries are ageing, with the share of people aged 65 and over expected to rise from 22% in 2024 to 29% by 2050. This demographic shift is expected to increase the burden of CVD, with estimates suggesting as much as a 90% rise in CVD prevalence in Europe between 2025 and 2050.

On top of demographics, a mix of factors increase the risk of CVD. More than three‑quarters of CVD deaths in the EU are linked to modifiable risks, with metabolic factors – such as hypertension, diabetes and obesity – accounting for 68%, behavioural risks for 37%, and environmental risks contributing 18%. Over the past decade, exposure to metabolic risks has largely risen or stayed high, while behavioural and environmental risks show mixed trends. Of the 15 CVD risk-related metrics presented in this report, eight have worsened, and the remaining seven indicate high levels of population exposure. One‑in-five (22%) people living in the EU lives with hypertension, another one‑in-seven live with obesity (15%), and one‑in‑13 (8%) live with diabetes. Depression and severe mental illness – including schizophrenia or bipolar disorder – are associated with increased risk of myocardial infarction, stroke, angina and coronary heart disease. Close to a third (27%) of adults aged 45 and over report at least four depressive symptoms.....

• Figure 3.16. Overall alcohol consumption among the population aged 15 and over, 2013 and 2023 p.165
• Figure 3.17. Less than one-in-five people aged 45 and older received advice on alcohol use p.166
• Annex Figure 3.C.1. Annual health expenditure due to diseases caused by harmful alcohol consumption above 1 drink per day for women and 1.5 drinks per day for men, in USD PPP per capita and as a percentage of total health expenditure, average 2020‑50 p.215
• Annex Table 6.A.2. European policies related to tobacco p.465