The latest European Society of Cardiology statistics show that cardiovascular outcomes have improved substantially over the past three decades. Yet population ageing, obesity, diabetes, environmental pressures and unequal access to care could erode that progress.
Cardiovascular disease remains the leading cause of death and disability across European Society of Cardiology member countries. Although fewer people are developing or dying from cardiovascular disease at a given age than 30 years ago, the overall burden remains immense. The European Society of Cardiology’s Cardiovascular Disease Statistics 2025 report brings together data from 56 countries and a population of more than 900 million people. It examines not only disease incidence and mortality, but also the demographic, social, environmental and clinical factors that shape cardiovascular health—and the healthcare systems available to respond.
Its central message is clear: Europe has made meaningful cardiovascular progress, but that progress is neither secure nor equally shared. In 2023:
- 121 million people were living with cardiovascular disease across ESC member countries;
- 9.3 million new cases were diagnosed;
- more than three million people died from cardiovascular causes; and
- cardiovascular disease accounted for 68 million disability-adjusted life years, reflecting both premature death and years lived with ill health.
Cardiovascular disease was responsible for approximately 39% of all deaths among women and 34% among men. Ischaemic heart disease remained the leading contributor, followed by stroke. Together, these conditions accounted for more than half of cardiovascular deaths.
There has nevertheless been important progress. The age-standardised incidence of cardiovascular disease fell by approximately 25% between 1990 and 2023. Ischaemic heart disease incidence declined by around 47%, while stroke incidence fell by approximately 42%. This creates an important paradox: cardiovascular risk and mortality at a given age may be falling, but the absolute number of people needing cardiovascular care remains high. People are living longer, surviving cardiovascular events and developing chronic conditions associated with ageing. Between 1970 and 2023, the proportion of people aged 65 or older across ESC member countries more than doubled, from 9.0% to 18.9%. Over the same period, median life expectancy increased from 69.5 to 78.3 years.
Longer lives are a major societal achievement. They also change the types of cardiovascular services populations require.Ageing increases the prevalence of multi-morbidity and conditions such as atrial fibrillation, heart failure and degenerative valve disease. These conditions often require long-term surveillance, repeated investigations, medication management, rehabilitation and coordinated care rather than a single episode of treatment. The report estimates that approximately 12.4 million people were living with atrial fibrillation in 2023, with around one million new cases occurring during the year. More than nine million people were living with heart failure, while almost 450,000 deaths were attributed to it.
Calcific aortic valve disease is particularly notable. It was the only major cardiovascular condition to show a dramatic increase in incidence over the previous three decades, reflecting population ageing as well as improved recognition and diagnosis. Health systems therefore need to prepare not simply for more cardiovascular events, but for more people living for longer with complex and interconnected cardiovascular conditions.
Hypertension remains the most significant modifiable cardiovascular risk factor in the European region. It affects an estimated 36.9% of adults and contributes to approximately one-quarter of all deaths. High cholesterol, smoking, obesity, diabetes, physical inactivity and poor diet continue to account for a large proportion of preventable cardiovascular disease. Some indicators have improved: smoking and non-HDL cholesterol have declined in many countries. However, these gains are increasingly threatened by the rise in overweight, obesity and diabetes.
Across ESC member countries:
- 57.4% of adults were overweight;
- 23.2% were living with obesity;
- obesity prevalence had risen by approximately 90% since 1990;
- around one-quarter of adults were insufficiently active; and
- 8.6% of people experienced moderate or severe food insecurity.
The report warns that increasing obesity and diabetes may cause recent declines in cardiovascular mortality to slow or plateau. These findings also challenge the idea that cardiovascular prevention can be delivered through patient education alone. People’s ability to eat well, exercise, avoid tobacco and obtain preventive care is shaped by income, employment, education, housing, neighbourhood design and access to affordable services. Effective prevention must therefore combine individual clinical support with wider fiscal, regulatory, environmental and social policy.
Environmental factors are estimated to contribute to more than 18% of cardiovascular deaths in Europe. Although fine-particulate air pollution has declined, exposure remains approximately twice as high in middle-income ESC countries as in high-income countries. Heat exposure is also increasing. In 2023, ESC countries experienced a median of 26.5 days with temperatures above 30°C, twice the number recorded in 1950. Middle-income countries experienced an average of 43.7 such days, compared with 6.5 in high-income countries. Air quality, heat resilience, housing, transport, access to green space and urban planning should consequently be regarded as components of cardiovascular policy. These are not peripheral environmental concerns: they influence cardiovascular events, service demand and health inequality.
The cardiovascular burden is not distributed evenly. Middle-income ESC countries generally experience higher disease incidence and substantially higher age-standardised mortality than high-income countries. Cardiovascular mortality rates remain approximately twice as high, and mortality improvements over the past three decades have been far smaller.
In high-income countries, cardiovascular mortality fell by more than half among both men and women. In middle-income countries, the corresponding reduction was only around 20%, while mortality increased in some countries. This inequality reflects more than differences in disease prevalence. Health expenditure per person was around five times higher in high-income countries. Lower income, reduced educational attainment, unemployment, environmental exposure and more limited access to prevention and specialist treatment all contribute.
Sex inequalities are also complex. Women experience lower rates of hypertension control, greater physical inactivity and rising obesity in several settings. Men remain more likely to smoke, consume larger quantities of alcohol and develop many forms of premature cardiovascular disease. National averages can obscure further inequalities associated with region, ethnicity and deprivation. A country may appear to perform well overall while particular communities continue to experience delayed diagnosis, poorer access and worse outcomes.
The Atlas also identifies enormous variation in cardiovascular workforce and procedure rates. The number of cardiologists ranged from fewer than 30 to more than 230 per million inhabitants. Women represented approximately 40% of cardiologists overall, but only around one-third in high-income countries. Representation was substantially lower in some procedural specialties and among cardiac surgeons.
Some areas show encouraging convergence. Percutaneous coronary intervention activity has grown rapidly in middle-income countries, and primary PCI rates have now overtaken those reported in high-income countries. This may reflect expanding interventional capacity and the higher burden of ischaemic heart disease. However, access to more advanced cardiovascular interventions remains concentrated in wealthier countries. Transcatheter valve procedures, catheter ablation, pacemakers, implantable cardioverter-defibrillators and cardiac resynchronisation therapy are generally performed less frequently in middle-income countries.
The differences are even more pronounced for heart transplantation, left ventricular assist devices and temporary mechanical circulatory support. Many middle-income countries report no transplantation or LVAD activity at all. Owning equipment is not the same as providing effective access. Technology requires trained professionals, functioning referral pathways, multidisciplinary decision-making, sustainable funding, quality assurance and long-term follow-up. In some cases, lower recorded rates may also reflect underdiagnosis rather than a genuinely lower burden of disease. This is particularly relevant to atrial fibrillation, peripheral arterial disease and valve disease, where access to specialist assessment influences detection.
What should health systems do next?
The report supports a dual approach: preventing more cardiovascular disease while creating systems capable of managing the large and growing population already living with it.
Prevention strategies must protect past gains in tobacco control, cholesterol reduction and blood-pressure management while responding more decisively to obesity, diabetes, inactivity and unhealthy food environments.
Services must also be redesigned around population ageing. Episodic, hospital-centred care will be insufficient for people living with atrial fibrillation, heart failure, valve disease and multiple long-term conditions. Better integration is needed between primary care, diagnostics, specialist services, rehabilitation, remote monitoring and supported self-management.
Equity should be made measurable. Access, waiting times, treatment and outcomes should be examined by geography, sex, ethnicity, deprivation and national income—not only through overall procedure volumes.
Finally, investment in technology must be matched by investment in people and pathways. Advanced diagnostics and treatments deliver little value when patients cannot reach them, staff cannot operate them or services cannot provide appropriate follow-up.
Read the full report: European Society of Cardiology’s Cardiovascular Disease Statistics 2025