Heart Disease Prevention Targets Missed Across Europe

MOST people with coronary heart disease across Europe are failing to meet recommended targets for preventing further cardiovascular events, according to a major international study.

The EUROASPIRE VI survey of 8,590 patients found that more than four in five had LDL cholesterol above recommended levels, while almost 60% were above the blood pressure target. Access to cardiac rehabilitation also varied substantially across Europe, with participation lowest in regions facing the greatest cardiovascular risk.

Are Heart Disease Prevention Targets Being Met?

People with established coronary heart disease remain at increased risk of further cardiovascular events, making management of factors including cholesterol, blood pressure, smoking, weight, and physical activity an important part of secondary prevention.

Researchers conducted the EUROASPIRE VI survey to determine how closely clinical practice across Europe reflects prevention and rehabilitation recommendations.

The observational study included 8,590 patients with coronary heart disease treated at 160 hospitals across 27 countries between September 2024–February 2026.

Countries were classified as having low, moderate, or high cardiovascular risk according to World Health Organization cardiovascular mortality data. Researchers assessed lifestyle factors, cardiovascular risk-factor control, medication use, and participation in cardiac rehabilitation.

Cholesterol and Blood Pressure Targets Frequently Missed

Despite having established coronary heart disease, many patients had inadequately controlled cardiovascular risk factors.

Overall, 82.7% had LDL cholesterol of at least 1.4 mmol/L, placing them above the recommended target. Almost six in 10 patients (59.8%) were above the blood pressure target of less than 130/80 mmHg.

Lifestyle-related risk factors were also common. Approximately one-third of patients (32.0%) were living with obesity, 33.5% reported low levels of physical activity, and 17.1% continued to smoke.

Almost one-third, 32.8%, had previously diagnosed diabetes. Amongst these patients, 42.2% had an HbA1c of at least 7%, indicating that recommended blood glucose targets were frequently not achieved.

Chronic kidney disease, another important cardiovascular risk factor, was present in 30.6% of participants.

The burden of these risk factors was consistently greatest amongst patients living in countries classified as having high cardiovascular risk.

Cardiac Rehabilitation Shows Major Inequalities

Researchers also identified substantial differences in access to cardiac rehabilitation, which supports recovery and secondary prevention through interventions including exercise, education, lifestyle modification, and risk-factor management.

Only 29.1% of patients attended at least one cardiac rehabilitation session. However, participation differed dramatically between countries, ranging from 0%–79%.

A particularly striking geographical divide emerged. Cardiac rehabilitation attendance reached 55.9% in low-risk regions and 29.7% in moderate-risk regions, but fell to just 10.2% in high-risk regions.

Patients who attended cardiac rehabilitation had significantly healthier lifestyles, better control of cardiovascular risk factors, and greater use of heart-protective medications.

However, because EUROASPIRE VI was observational, the study cannot establish that cardiac rehabilitation directly caused these better outcomes. People who participate in rehabilitation may differ from non-participants in other important ways.

The findings instead highlight a significant gap between cardiovascular prevention recommendations and routine clinical care, particularly in European regions with the greatest burden of disease.

The researchers describe the pattern as evidence of “inverse care”, whereby patients in the highest-risk regions have the lowest participation in cardiac rehabilitation despite potentially having the greatest need.

The authors conclude that improving implementation of secondary prevention and expanding access to cardiac rehabilitation will be central to addressing persistent inequalities in cardiovascular care across Europe.

Reference

Wood D A et al. ESC Guidelines on prevention and rehabilitation in coronary heart disease and current practice: the EUROASPIRE VI survey. Eur Heart J. 2026. DOI:10.1093/eurheartj/ehag741.

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