The untapped promise of secondary prevention: why delivery, not discovery, is Europe’s next cardiovascular breakthrough

Cardiovascular disease (CVD) remains Europe’s leading killer, responsible for almost four million deaths annually and imposing an economic burden estimated at €282 billion each year. Despite remarkable advances in acute cardiac care, progress in reducing cardiovascular mortality has begun to plateau. This suggests that the next frontier in cardiovascular health is not simply treating heart attacks and strokes when they occur, but preventing recurrent events among people who already have established cardiovascular disease.

A new study published in the European Journal of Preventive Cardiology provides compelling evidence of just how much could be gained by improving secondary prevention across Europe. It estimates that optimising treatment and risk-factor control among patients with established atherosclerotic cardiovascular disease (ASCVD) could generate more than 94,000 additional cardiovascular-event-free life years every year across seven European countries: Denmark, France, Germany, Italy, Poland, Spain, and the United Kingdom.

What matters here is not a new treatment, but the cost of under-delivery: for policymakers managing tight budgets, meaningful health gains may be possible simply by making fuller use of the tools already available, without waiting for the next medical breakthrough.

Why secondary prevention matters

Secondary prevention focuses on people who have already experienced or been diagnosed with cardiovascular disease. These individuals are at particularly high risk of suffering another heart attack, stroke, or cardiovascular death. Clinical guidelines clearly recommend aggressive management of key risk factors, including hypertension, high cholesterol, diabetes, and smoking. Yet large European studies such as EUROASPIRE (a long-running clinical audit tracking real-world care across Europe) have repeatedly highlighted a substantial gap between guideline recommendations and actual practice. Many patients continue to have poorly controlled blood pressure, elevated cholesterol levels, unmanaged diabetes, or ongoing tobacco use despite being known to healthcare systems. The question addressed by the study is simple but powerful: What would happen if more patients received effective secondary prevention and achieved recommended treatment targets?

Modelling the benefits of better care

The research combined population data from seven European countries with a validated risk-prediction model to estimate future cardiovascular events in people with established heart disease, focusing on four modifiable risk factors: hypertension, high cholesterol, diabetes, and smoking. Current levels of effective treatment and risk-factor control across Europe were estimated at approximately 43%. Researchers then modelled what would happen if that rose to 70%. Importantly, the study was not evaluating any single intervention or drug, but, rather, it was measuring the benefit of simply closing the gap between what guidelines recommend and what patients actually receive.

A striking result: 94,359 additional event-free life years annually

The findings were remarkable. Across the seven countries studied, improving secondary prevention from current levels to 70% coverage could yield 94,359 additional cardiovascular-event-free life years annually. The gains varied by country: Germany (25,333 event-free life years), Italy (21,144), France (14,584), United Kingdom (13,324), Spain (9,393), Poland (9,369), and Denmark (1,212). These numbers represent years of life lived without recurrent heart attacks, strokes, or cardiovascular death. In practical terms, they translate into thousands of people remaining healthier for longer, maintaining independence, reducing disability, and avoiding costly hospitalisations.

More than a clinical success story

What makes this study particularly relevant is its policy perspective. Much cardiovascular research focuses on new drugs, devices, or procedures. This study instead demonstrates the enormous value that could be unlocked simply by ensuring proven therapies reach the patients who need them. The interventions required are neither experimental, nor futuristic. These treatments already exist. The challenge lies in delivery, adherence, and systematic implementation. For policymakers the message is clear: better use of existing evidence-based approaches could deliver substantial benefits now.

The importance of integrated cardiovascular health strategies

The findings support national and European cardiovascular health plans aimed at identifying high-risk patients earlier and ensuring timely, guideline-directed treatment. For policymakers, the practical levers are reasonably well established. For example: earlier screening for at-risk patients, secondary prevention clinics built into standard post-event care, and closer coordination between primary and specialist teams. None of this requires new technology, just sustained commissioning attention. The case will only grow stronger as European populations age and cardiometabolic disease becomes more common.

Narrowing the gap between clinical guidelines and real-world practice could add tens of thousands of healthy years for patients living with ASCVD across these seven countries alone.

The most important message from this study is that Europe already possesses many of the tools needed to reduce cardiovascular morbidity and mortality. The challenge is not discovering what works, it is ensuring that what works is consistently delivered.

As healthcare systems continue to grapple with growing cardiovascular burdens, prevention must move from a desirable addition to a central strategic priority.