CVD+D: Why the EU needs a comprehensive cardiovascular-diabetes health plan

This election year, Europe needs to step up action against the silent pandemic of diabetes. Whereas 32 million people in the European Union currently live with diabetes, this figure is set to rise to 33.2 million by 2030.

Stefano Del Prato (Chair of EUDF) and Bart Torbeyns (Executive Director of EUDF) pen this op-ed on behalf of all EUDF members.

Indeed, a major study in the Lancet found that the number of people with diabetes in the EU could reach over 55 million by 2050. The data is clear: European policymakers must move swiftly towards comprehensive policy action on diabetes.

In the absence of such action, millions of lives will continue to be cut short and our health systems risk being overwhelmed by preventable costs, largely due to cardiovascular diseases (CVD). It is indeed estimated that at least a third of the people with diabetes have a cardiovascular condition and this is the leading cause of mortality among in this population.

Even before COVID-19, there was a salutary rise of health issues on the EU policy agenda. The European People’s Party (EPP) led by Manfred Weber greatly contributed to this by pledging during the 2019 elections to take action on cancer. This eventually led to the von der Leyen Commission launching Europe’s Beating Cancer Plan, an unprecedented disease action armed with 4 billion euros to finance various initiatives.

This year, the EPP is shifting the focus. The EPP manifesto, recently adopted in Bucharest, pledges to “launch a European Cardiovascular Health Plan, as cardiovascular disease is the biggest killer in the EU.” The Christian Democrats want to do this as part of a broader push to increase equitable access to health care, make our health systems more resilient and turn the EU into a global health innovation hub.

These ambitions are welcome and necessary. One thing needs to be clear however: any European plan addressing CVD will only be effective if it is associated with a comprehensive diabetes plan.

Given the intimate links between CVD and diabetes, and the rising prevalence of both conditions, an integrated EU Cardiovascular Diseases and Diabetes Plan (CVD+D) could offer a cost-effective and holistic solution to two of Europe’s most pressing health challenges. Such a plan would simultaneously foster appropriate care with effective preventative measures. As such, a combined CVD+D Plan makes the most sense medically, economically, humanly and politically.

The EPP manifesto acknowledges some of the links between CVD and diabetes. The proposed CVD plan would “include a European Knowledge Centre and promote joint cardiovascular and diabetes health checks, as 85% of the people living with diabetes die from cardiovascular disease”. This is a significant step but does not go far enough towards a genuinely comprehensive approach. Early detection of diabetes is crucial but must be followed by appropriate action. Europe then needs a broader diabetes plan with on dedicated policy initiatives on diabetes prevention and care across all Member States.

The rationale for tackling CVD and diabetes together is clear. Medical professionals and researchers know well the intricate ties between these two disease areas. People with diabetes are about three times more likely to develop cardiovascular diseases such as heart attack, stroke and artery diseases affecting blood supply to the legs and feet. In spite of significant therapeutical advances, people with diabetes still have twofold greater risk of cardiovascular death. Diabetes can cut life expectancy by 5 to 13 years on average depending on the age diagnosis.

Conversely, prevention, early detection and proper control of diabetes can reduce the risk of CVD events and death. Recent studies demonstrate that, among people with diabetes, even a one-year delay in achieving tight glycaemic control is associated with significantly increased risk of myocardial infarction, stroke, heart failure and other cardiovascular events. In short, the prevention of many cardiovascular disorders depends on establishing bold policies ensuring early detection and effective treatment of diabetes. This should include with smooth connections between cardiologists and medical professionals working on managing diabetes.

The economic case for investing in diabetes prevention and care is compelling. Whereas diabetes costs healthcare systems in the EU around 104 billion euros every year, 75% of these costs are due to avoidable complications that can be prevented through proper diabetes management. What’s more, productivity losses due to diabetes are estimated to cost the EU around 65 billion euros per year. Investing in diabetes prevention and care can then yield massive dividends for the sustainability and resilience of our health systems.

To tackle the rising tide of diabetes, Europe’s united diabetes community has come together to issue the Diabetes Community Pledge. It outlines a range of concrete actions to improve early detection, care, people’s empowerment and research on diabetes. Among its 15 recommendations, the Pledge calls on Member States to introduce health check programmes in all age groups for all types of diabetes and their most frequently associated co-morbidities, including cardiovascular diseases.

Tackling CVD and diabetes together is also politically sound. The European Commission has recognised the importance of tackling these two disease areas together by launching and financing the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI). Started in November 2023 with funding from the EU4Health programme, JACARDI will deploy 53 million euros to help 21 countries reduce the burden of these diseases. Significantly, the impetus to tackle CVD and diabetes together came from member states, suggesting such an approach can command the widespread buy-in needed for European policies.

JACARDI’s 142 pilot projects will do precious work, such as improving health literacy and awareness, care pathways, screening and implementing prevention action among at-risk populations. Beyond pilot projects, however, we need a robust and comprehensive EU CVD+D Plan to entrench needed actions in the years to come.

A European CVD+D Plan should include an implementation roadmap with concrete targets, timetables, progress indicators, cross-country initiatives and support for updating and enhancing national strategies. This also has to be backed by adequate funding to turn European objectives into longer and better lives.

Political will is needed at both national and European level not only for our health systems to keep up with the steadily rising prevalence of diabetes and cardiovascular diseases but ultimately to bend the curve.

There is no time to lose: Europe’s population is ageing, overweightness and obesity are on the rise, health budgets are under strain and healthcare staff shortages are increasingly widespread. Decisive action is needed to save lives, improve Europeans’ quality of life and prevent our health systems from being overwhelmed.

An ambitious European CVD+D Plan would put Europe ahead of a mounting health crisis and lay the foundations for more resilient health systems. This 2024 election year is critical: let’s commit to the right actions now to reap the benefits in the years and decades to come!