Cardiovascular disease (CVD) is the leading cause of death worldwide. As populations age and grow, the total number of cases continues to increase, creating a widening prevention gap.

The longevity dividend has created a “prevention debt,” Thomas Münzel, PhD, cardiologist, and chair of the European Society of Cardiology Working Group on Environmental Sustainability, noted while speaking to El Médico Interactivo, a Medscape Network platform, following the society’s recent congress in Madrid, Spain.

The latest update from the Global Burden of Cardiovascular Diseases highlights this growing challenge as longer lifespans make CVD prevention increasingly difficult.

Hypertension and Risk Factors

Controlling hypertension is essential as it is a key modifiable risk factor for CVD. According to the World Health Organization (WHO), only 54% of individuals with hypertension are diagnosed, 42% receive treatment, and 21% achieve blood pressure control. Increasing global control rates to 50% could prevent an estimated 76 million premature deaths by 2050.

Obesity and diabetes further increase the risk for CVD. “What was previously considered a risk factor is now recognised as a disease that promotes cardiovascular complications throughout life,” Münzel said. The World Heart Report 2025 highlights obesity as a critical factor in CVD prevention, particularly in middle-income countries.

Climate Change

Climate change is an emerging threat to cardiovascular health. Europe has already experienced tens of thousands of heat-related deaths each summer, and without robust adaptation, heat-related mortality in cities is expected to increase. “Environmental exposures add further weight. Air pollution and noise remain among the most important environmental determinants of CVD,” Münzel emphasised, citing the European Environment Agency’s 2025 assessment.

Tobacco and new nicotine products, including flavoured electronic cigarettes, heated tobacco, and nicotine pouches, also pose significant risks. The WHO has called for bans on flavouring, and the EU is developing fiscal and regulatory measures to address these products.

European Policy

Europe is addressing rising CVD through coordinated policies centred on a dedicated EU Cardiovascular Health Plan. At the end of 2024, EU health ministers endorsed the action, and in August 2025, the European Commission launched a call for evidence to guide the plan. “The strategy will combine prevention, early detection, improved care pathways, better use of data, and a focus on equity,” Münzel said.

The plan is complemented by the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI) under EU4Health, which involves 21 countries and over 70 institutions to scale best practices, support national implementation, and enhance knowledge sharing.

Clean air is now recognised as a cardiovascular priority. The revised 2024 Ambient Air Quality Directive tightens limits on fine particulate matter and nitrogen dioxide in line with WHO guidelines and strengthens monitoring and enforcement. “This is a crucial step as reducing pollution directly reduces cardiovascular morbidity and mortality,” Münzel said.

The EU also addressing climate-related cardiovascular risks through heat adaptation strategies. “Countries are implementing action plans on heat and health, strengthening monitoring, and piloting interventions such as urban greening, shading, and cooling centres,” Münzel explained.

Prevention policies also extend to nutrition; for instance, Finland’s North Karelia Project showed that population-wide modification of risk factors could reduce coronary mortality by over 80% over several decades.

“The United Kingdom’s soft drinks tax successfully incentivised manufacturers to reduce sugar, producing measurable reductions at the household level and long-term health benefits,” Münzel said. Portugal’s legal limit for sodium in bread is another effective intervention.

Tobacco and nicotine are central to these regulations. The European Commission has proposed revising the to include e-cigarettes, heated tobacco, and nicotine pouches, with expected implementation by 2028.

Münzel disclosed having no relevant financial relationships. 

This story was translated from El Medico Interactivo.