Circulatory (or cardiovascular) diseases remain the leading cause of mortality in most EU countries, accounting for over 1.7 million deaths (or 32% of all deaths) in the EU in 2021.
Age‑standardised mortality rates from circulatory diseases are four to seven times higher in Bulgaria, Romania and Latvia than in France, Denmark, Spain and Luxembourg (Figure 3.7). The gaps reflect differences in the prevalence of risk factors such as smoking, obesity and alcohol consumption as well as differences in quality of care. For example, 30‑day mortality following heart attack (which reflects processes such as timely transport of patients and effective medical treatment) was above 14% in Latvia, the Slovak Republic, Lithuania and Estonia in 2021, compared to 7% or less in Sweden, Denmark and Spain (see indicator “Mortality following acute myocardial infarction” in Chapter 6).
On average between 2011 and 2021, mortality rates from circulatory diseases decreased by nearly 20% in the EU (Figure 3.7). While all EU countries experienced a drop in circulatory mortality rates during this period except Bulgaria, decreases ranged from as little as 3% in Romania to 48% in Malta. Decreases in Central and Eastern European countries tended to be smaller than among Western European countries, pointing to growing geographic disparities.
Among circulatory diseases, the leading cause of death in the EU was ischemic heart disease (IHD), responsible for a third of all deaths in this category (567 000 deaths). The second leading cause was cerebrovascular diseases (strokes), accounting for 357 000 deaths or slightly more than one‑fifth of all circulatory disease deaths in the EU. The large geographic gradient in terms of circulatory disease mortality rates highlighted in Figure 3.8 generally remains consistent when analysing IHD and stroke separately. Most EU countries that have high mortality rates from IHD also have high mortality rates from strokes.
Men in the EU have 43% higher age‑standardised death rates from circulatory diseases than women, and this gender gap has grown slightly over the past decade. This gender gap is related to the higher prevalence of key risk factors among men, including smoking, high blood pressure and high cholesterol and a younger age of onset of cardiovascular disease among men.
For both genders, circulatory disease mortality rates are generally higher among people from lower socio-economic status (OECD/The King's Fund, 2020[1]). A study covering 11 European countries found that socio-economic gaps in circulatory disease mortality rates were the largest in Central and Eastern European countries and in Baltic countries (Di Girolamo et al., 2020[2]). Higher prevalence of risk factors among lower socio-economic groups is a major driver of poorer cardiovascular outcomes. Lower socio-economic groups also have poorer access to healthcare, reducing the likelihood of early diagnosis and proper medical management of circulatory diseases such as blood pressure and cholesterol-lowering medications.
The COVID‑19 pandemic has had an impact on the incidence and mortality from circulatory diseases as COVID‑19 infection is associated with increased risk. This can be expected to continue to have an impact in the coming years, particularly among those with more severe and long COVID (Espinosa Gonzalez and Suzuki, 2024[3]).
Focusing on primary prevention and effective care can reduce the incidence and mortality from circulatory diseases. For example, research findings shared by the European Society of Cardiology show that patients with heart disease who quit smoking can reduce the risk of death or heart attack by nearly half, and that even a modest reduction in weight can significantly reduce metabolic risk factors for circulatory diseases such as high blood pressure (The ESC Scientific Document Group, 2024[4]). Healthcare providers have a key role to play in early detection of circulatory diseases and proper management of diagnosed patients. In addition, new technology such as wearable sensors and mobile applications can facilitate remote monitoring of patients, supporting earlier intervention in cases of worsening circulatory disease symptoms, as well as patient engagement in managing their condition.
