Background
Cardiovascular diseases (CVD) are the number one killer in the European Union (EU), responsible for one in three deaths across the Union (1). Currently, CVDs claim more lives annually than all cancers combined. Beyond the devastating effect on people’s lives, CVDs represent a significant burden to the EU economy. The annual economic cost of CVD is estimated at EUR 282 billion (see figure 1). Nevertheless, the burden is not equally distributed across Member States, with some having 6.3 times higher death rates than other. For these reasons, the EUs cardiovascular and public health community had long called for the development of such dedicated health plan (2).
On the 16th of December 2025 the Commission made a strategic response to this need by adopting the Communication on an EU cardiovascular health plan: the Safe Hearts Plan (3). The plan arrives at a key moment in which the EU’s political priorities have shifted to regaining economic competitiveness. It is evident in the plan how through public health the economic resilience of the bloc can also be safeguarded.
Figure 1 Economic and financial burden of CVD across the EU (1)
Structure of the Communication
The Safe Hearts Plan is designed to address the entire disease pathway by building on three pillars: prevention, early detection and screening, and treatment and care (including rehabilitation). Additionally, it is supported through three cross-cutting themes on digital innovation, research and knowledge, and tackling inequalities. This structure aims to resemble Europe’s Beating Cancer Plan (EBCP), following the objective of drawing from this previous plan to develop new health plans (4).
Key initiatives
The plan sets measurable targets, including to achieve by 2035 a 25% reduction in cardiovascular premature mortality with respect to 2022 (17.9 per 100 000 inhabitants). To achieve this target the Plan outlines 10 flagship initiatives. Of these, five flagship initiatives are on prevention, one on early detection and screening, and one on treatment a care. The remaining three flagship initiatives cover each of the three cross-cutting themes.
From the ten initiatives, four flagship initiatives involve legal acts: 1) the modernisation of tobacco control legislation (Revision of the Tobacco Products Directive); 2)a proposal for a Council Recommendation on vaccination against respiratory infections; 3) a proposal for a Council Recommendation on health checks for CVDs; 4) a proposal for a Council recommendation on personalised treatment and monitoring of CVDs.
Analysis
This new Plan shows a continuation in the development of the European Health Union (EHU), building on the ongoing work on the EBCP. The Safe Hearts Plan, while overall less ambitious than the EBCP in both financial scope and policy reach, highlights the important role that prevention has in EU health policy and shows the commitment of the Commission to addressing major early causes of mortality.
Additionally, the Plan expects Member States to develop national cardiovascular health plans by 2027 without setting concrete elements that should be covered within the national plans, including whether they will encourage Member States to develop legislation in key aspects for the single market that the EU might not legislate (e.g. alcohol health warnings, front-of-pack nutritional labelling). The recent study on evaluation of the EU childhood obesity action plan conducted by Open Evidence showed that Member States call for greater support from the European Commission on issues that relate to creating healthy living environments (5).
A notable limitation is the Plan’s reliance on Member States for implementation, primarily through non-binding instruments and initiatives that lack defined measurable outputs. From these four flagship initiatives that involve legal acts, only the Revision of the Tobacco Products Directive (TPD) represents is binding legal act. This provides for a key difference with the EBCP, which called for numerous legislative proposals from the Commission. While providing the necessary recommendations, studies, and guidelines for Member States is essential to support their effective and efficient implementation of measures, this has considerable limits. No acting with binding instruments restricts the direct impact that EU action can have on citizens across the Union and reduce health inequalities within and between Member States. More importantly, multiple elements have an impact on the single market and would justify action under Article 114 TFEU.
Additionally, the Plan fully aligns with the Commission Competitiveness agenda by putting cost-effectiveness and ‘economic resilience’ at the centre of the EU agenda, even in the case of a public health policy. The high burden of CVD is therefore not considered exclusively a threat to public or individual health, but it is treated also as an economic threat, moving heart health, and its safety, to the centre of the competitiveness agenda: making Europe more resilient.
Finally, the development of an EU cardiovascular health inequalities dashboard is commended. The European Cancer Inequalities Registry (ECIR) has been a success to monitor inequalities. However, the development of the dashboard should not be an end-goal in itself, but a intermediate initiative towards a great outcome of reducing inequalities. Additional specific initiatives to act on the data from dashboard and reduce inequalities are missing.
Conclusion and how Open Evidence can contribute
The Safe Hearts Plan is a key starting point to address the burden of Europe’s biggest killer. Through it, the Commission has laid the work for the next years in this area of health policy. However, the Plan should not prevent further action if evidence from the Plan or other sources shows that the EU needs to take stronger measures to tackle CVD, including adopting legislation where appropriate under Article 114 TFEU.
Open Evidence is committed to support its clients in achieving its end objectives in health policy, by assisting with research that successfully informs evidence-based policy making. Open Evidence applies different methodologies to provide relevant research for the competitiveness agenda, with our economic analysis, through econometric modelling, supporting the quantification of the economic burden of different conditions and the impact that adopting different policies might have to tackling these.
Contributor: Silvia Grothe Riera
References:
- OECD (2025). The State of Cardiovascular Health in the European Union. Available at: https://www.oecd.org/en/publications/the-state-of-cardiovascular-health-in-the-european-union_ea7a15f4-en/full-report.html [Accessed on 16th December 2025]
- European Society of Cardiology (2025). Press release: The European Society of Cardiology enthusiastically welcomes the Safe Hearts Plan. Available at: https://www.escardio.org/The-ESC/Press-Office/Press-releases/european-society-of-cardiology-enthusiastically-welcomes-the-safe-hearts-plan [Accessed in 16th December 2025]
- European Commission (2025). Communication from the Commission to the European Parliament, the Council, the Economic and social committee and the committee of the regions on an EU cardiovascular health plan: the Safe Hearts Plan. COM(2025) 1024 final. Available at: https://health.ec.europa.eu/document/download/dfb60cde-21a5-426d-8616-e394a326abc2_en?filename=ncd_com-2025-1024_act_en.pdf
- European Commission (2024). Mission letter to Olivér Várhelyi. Available at: https://health.ec.europa.eu/document/download/dfb60cde-21a5-426d-8616-e394a326abc2_en?filename=ncd_com-2025-1024_act_en.pdf [Accessed on 16th of December 2025]
- European Commission: European Health and Digital Executive Agency, Open Evidence, PwC EU Services, SAFE Food Advocacy Europe, Liva, G., Grothe i Riera, S., & Spolverato, G. (2025). Study on the evaluation of the EU action plan on childhood obesity: final report, Publications Office of the European Union. https://data.europa.eu/doi/10.2925/4805896