Cardiovascular strategy: the EU Safe Hearts Plan

The Safe Hearts Plan is structured around three fundamental pillars – prevention, early detection and screening, and treatment and care – supported by three cross-cutting themes addressing digital innovation, research and knowledge, and health inequalities (European Commission, 2025). This integrated approach recognises that nearly 80% of cardiovascular diseases can be prevented through lifestyle modifications, with prevention currently receiving only 3% of total healthcare spending despite being the most cost-effective investment in cardiovascular health (European Commission, 2025; World Heart Federation, as cited in European Commission, 2025).

Central to the preventive approach proposed by the Commission are comprehensive dietary interventions and food system reforms, tobacco control measures, physical activity promotion and environmental risk reduction strategies designed to address the growing burden of obesity, diabetes and other metabolic risk factors that drive cardiovascular disease development.

The scale of the challenge

Current epidemiological data reveal alarming trends that underscore the urgency of coordinated EU action. Between 2025 and 2050, the global prevalence of cardiovascular diseases is projected to rise by 90%, with deaths increasing by 73.4% to reach an estimated 35.6 million in 2050, up from 20.5 million in 2025 (Chong et al., 2025). This projected increase is driven substantially by the rising prevalence of major cardiovascular risk factors that are themselves reaching epidemic proportions also across the EU.

Hypertension, identified as the main risk factor for cardiovascular diseases, affects almost 25% of adults. Obesity affects 15% of adults and 9% of children, with 75% of obesity-related excess deaths attributable to cardiovascular diseases (Koskinas et al., 2024), while overweight in the EU involves more than half of adults, with adolescent overweight rates increasing from 17% in 2014 to 21% in 2022. Diabetes prevalence has also risen, by 22% between 2012 and 2022. These conditions do not exist in isolation; cardiovascular diseases occur frequently together with diabetes and obesity, creating a complex web of comorbidities that significantly impacts people’s quality of life.

Almost a third of cardiovascular-related morbidity and mortality in Europe is due to uncontrolled cholesterol, with the prevalence of elevated cholesterol levels exceeding 50% in Europe (Timmis et al., 2022). Significant geographical inequalities exacerbate the problem, with cardiovascular death rates nearly 6.3 times higher in some Member States than in others, whilst lower income and education population groups experience both higher prevalence of risk factors and higher mortality rates. Environmental factors, particularly air pollution, account for 18% of cardiovascular deaths in the EU, with socio-economically disadvantaged groups facing disproportionate exposure to multiple risk factors including unhealthy diets, smoking and pollution (European Environment Agency, 2025).

Pillar 1: Prevention – a life course approach

The flagship initiative ‘EU cares for your heart’ programme represents a comprehensive, lifelong prevention strategy that will support all 27 Member States in developing or implementing national cardiovascular health plans by 2027 (European Commission, 2025). This programme will invest in digital tools and personalised medicine approaches, particularly targeting vulnerable groups and empowering both patients and healthcare professionals. Updated estimates on national spending on preventive cardiovascular health will, through an EU-funded OECD project, allow Member States to benchmark their investments, identify gaps and receive strategic guidance on how to allocate resources more efficiently.

Dietary interventions and food processing reform

Healthy dietary habits, including daily fruit and vegetable intake and consuming less sugar, saturated fats and salt when consumed disproportionately within a daily or weekly diet, reduce the risk of cardiovascular diseases (European Commission, 2025). Emerging research also highlights the role of diet in shaping the gut microbiome, thus opening new avenues for personalised medicine to address risk factors. Dietary habits also influence oral health, which is in turn a vital element of cardiovascular health (Hopkins et al., 2024).

The Commission supports actions to improve dietary habits through the food industry-led EU Code of Conduct on Responsible Food Business and Marketing Practices (also called the Agri-food Code) and Food 2030, the research and innovation policy framework deployed under the Horizon Europe programme (European Commission, 2025). The Commission supports national reformulation initiatives to reduce saturated fats, sugar and salt levels and promotes fruit and vegetable consumption. The successful EU school scheme on fruits, vegetables and milk products has been reviewed and proposed for continuation beyond 2027 (European Commission, n.d.).

A recently published report by the Joint Research Centre on criteria for sustainable public procurement for food, catering services and vending machines (García-Herrero et al., 2025) can be used by local governments to ensure that healthy foods are served in public institutions such as schools, hospitals and government facilities. The Commission will work towards a new comprehensive food processing assessment system, looking into portions, frequency of intake and role in the diet, to empower consumers with transparent, accessible, science-based digital information on food processing (European Commission, 2025).

Based on the outcome of the study on so-called ‘ultra-processed foods‘, the Commission will examine which appropriate tools, including possible financial actions, could be deployed to support and fund public health actions in primary prevention and stimulate food reformulation and healthier consumer choices (European Commission, 2025). The Commission intends to establish a network of competent authorities to provide a forum for cooperation and coordination in the taxation of unhealthy food products to support the exchange of information and best practices amongst Member States, and to set up a database of such taxes or levies in force.

Tobacco control and taxation

Tobacco control remains paramount, with the Commission intending to propose a revision of the legislative framework on tobacco control in 2026, targeting the long-term goal of fewer than 5% of adults using tobacco by 2040 (European Commission, 2025). This initiative addresses the alarming 45% increase in vaping and the proliferation of novel nicotine products, such as heated tobacco products, e-cigarettes and nicotine pouches, particularly among young people.

The revision of the Tobacco Taxation Directive, adopted on 16 July 2025, aims to raise excise duty rates on traditional tobacco products and harmonise taxation on novel tobacco and nicotine products (European Commission, 2025). This recognises that approximately 40% of the decline in smoking over the past decade can be attributed to taxation measures, which the WHO identifies as one of the most effective instruments in curbing tobacco consumption.

Focus on children and young people

Prevention of cardiovascular diseases, diabetes and obesity must start in childhood (European Commission, 2025). The Commission is funding collaborative actions between Member States and stakeholder-led projects that promote healthy eating and physical activity through education, policy and community engagement. Research projects are focusing on identifying risk factors, improving healthy diets, promoting prevention and developing personalised interventions to support lifelong healthy lifestyles specifically for children and young people. However, fewer than 1 in 5 boys and 1 in 10 girls (5-17 years) meet the WHO’s recommended level of physical activity.

The Commission intends to propose an update of the Council Recommendation on promoting health-enhancing physical activity across sectors and strengthen awareness of the link between regular physical activity and cardiovascular health through annual Europe-wide campaigns, including the #BeActive campaign and the European Week of Sport (European Commission, 2025). Starting in June 2026, these initiatives will aim to engage millions of Europeans across more than 50,000 events each year. The Commission will continue to provide EU funding to support physical activity, including its crucial role in prevention, through programmes such as Erasmus+ and EU4Health.

Children and young people are particularly vulnerable to marketing on so-called ‘ultra-processed’ foods and foods high in fat, sugar and salt, as well as tobacco and emerging products (European Commission, 2025). The Commission intends to evaluate the Audiovisual Media Services Directive, which includes rules to protect minors from harmful content, by the end of 2026, and consider a proposal for its revision to limit children’s exposure to marketing of unhealthy foods and tobacco products. The Commission will present a ‘Toolkit for Child and Adolescent Health and Mental Wellbeing Promotion’ by the end of 2026 to support policymakers in improving the physical and mental health of children.

Pillar 2: Early detection and screening

Early detection and screening represent essential public health tools for cardiovascular disease prevention, enabling timely identification of individuals at high risk before symptoms emerge (European Commission, 2025). Cardiovascular diseases, unlike cancer, lack a harmonised protocol for early detection and diagnosis, resulting in fragmented approaches across the EU that hinder data collection and cross-border comparison. The Safe Hearts Plan includes the development of an EU protocol on health checks to improve timely detection and early diagnosis, reduce health inequalities and lower healthcare costs.

In 2026, the Commission will propose a Council recommendation on health checks for cardiovascular diseases to support a common approach for Member States in developing and implementing national health checks (European Commission, 2025). The protocol will include screening for traditional risk factors such as high blood pressure, cholesterol and blood sugar, as well as emerging areas including kidney disease, familial hypercholesterolaemia, cardiomyopathies and obstructive sleep apnoea. The Commission intends to support pilot-testing and launch of the EU protocol on health checks in Member States, as well as launch awareness campaigns (‘Know Your Numbers’) to support this initiative.

Specific targets have been established to measure progress: by 2035, at least 75% of people aged 25 to 64 and at least 90% of those aged 65 and older should have their blood pressure measured annually by a health professional (European Commission, 2025). Similar targets apply to cholesterol and blood sugar measurements, with at least 65% coverage for the younger age group and 80% for those aged 65 and older. The Council recommendation would also support the identification and implementation of incentives to participate in screening programmes.

Pillar 3: Treatment, care and rehabilitation

While prevention is key, access to high-quality, coordinated and patient-centred care remains essential for the many individuals living with cardiovascular diseases (European Commission, 2025). Many people live with multiple chronic diseases and therefore require long-term, multidisciplinary support and care. Evidence shows that personalised treatments and care can reduce healthcare costs and improve quality of life (Casassus, 2025). Approaches to stratify patients, such as pharmacogenomics, can improve treatment outcomes, notably by predicting treatment response and reducing complications and adverse effects.

The Commission intends to propose a Council recommendation in 2027 on personalised treatment and monitoring of cardiovascular diseases to improve the quality and consistency of integrated care pathways for cardiovascular diseases and related conditions, including using digital tools (European Commission, 2025). This proposal is envisaged to complement and inform the deployment of digital and AI-based solutions supported under the EU4Health programme and help to improve access to essential treatments across the EU.

The Commission intends to establish an EU network of cardiovascular health centres to bring together expertise and facilitate the uptake of diagnosis and treatment, as well as rehabilitation and long-term care and effective management, including adherence to treatment and medical advice (European Commission, 2025). Rehabilitation after acute events, such as heart attacks or strokes, is vital in reducing the risk of death and disabilities. It must be multidisciplinary and comprehensive, addressing physical, psychological and social needs. To ensure truly personalised care, it is essential to apply lived experience across the cardiovascular disease continuum, especially in management and care approaches.

Research and innovation

To date, the EU has invested almost €2.3 billion in cardiovascular and related research through EU framework programmes for research and innovation (European Commission, 2025).

Research priorities include research on the role of sustainable and healthy diets for cardiovascular disease prevention with the support of digital tools, including the link between nutrition, the gut microbiome and cardiovascular disease (indicative funding €12 million from Horizon Europe Cluster 6).

Targets and monitoring framework

The Safe Hearts Plan establishes clear, measurable targets to guide implementation and monitor progress. By 2035, the EU aims to achieve a 25% decrease in cardiovascular premature mortality compared with the 2022 baseline year (European Commission, 2025). In 2022, the most common cause of premature death was ischaemic heart disease with 77,704 deaths (17.9 per 100,000 inhabitants). These targets will support Member States’ progress towards Sustainable Development Goal 3.4, which aims to reduce premature mortality from cardiovascular diseases, diabetes and other key non-communicable diseases through prevention and treatment by one third by 2030.

The Commission intends to create a network of cardiovascular and diabetes experts, including medical societies and patient organisations, to support implementation and knowledge exchange (European Commission, 2025). Direct grants to Member States funded with €5 million under the EU4Health 2025 work programme will support this network. The Commission will continue to develop actions with Member States through the Expert Group on Public Health, which is the main forum for discussions on the prevention and management of cardiovascular diseases and other non-communicable diseases. The Commission will support targeted actions (€2 million funding under EU4Health 2025) to reduce cardiovascular disease and diabetes risk amongst vulnerable groups, especially women.

Conclusion

The Safe Hearts Plan represents a comprehensive, ambitious and evidence-based response to the EU’s most pressing public health challenge. By prioritising prevention through comprehensive dietary interventions, food system reform, tobacco control and physical activity promotion, establishing standardised early detection protocols, improving treatment and care pathways, and leveraging digital innovation, the plan provides a coordinated framework for reducing the devastating impact of cardiovascular diseases, diabetes and obesity across the EU. The emphasis on addressing modifiable risk factors -particularly through healthy dietary habits, reformulation of ultra-processed foods, sustainable public procurement and consumer empowerment – reflects the evidence that nearly 80% of cardiovascular diseases can be prevented through lifestyle modifications.

With concrete targets, substantial investment in research and innovation, and a commitment to addressing health inequalities, the Safe Hearts Plan lays the foundation for sustained, patient-centred action at both national and EU level (European Commission, 2025). The plan’s comprehensive approach to prevention, from childhood nutrition programmes and school food schemes to taxation measures on unhealthy products and the development of a new food processing assessment system, demonstrates recognition that cardiovascular health begins with what citizens eat and the environments in which they live, work and make daily choices about their health.

Dario Dongo

Cover art copyright © 2025 Dario Dongo (AI-assisted creation)

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