The challenge we face: Treating symptoms instead of causes

Europe is treating the symptoms of a crisis while ignoring the drivers behind it. By the time an EU citizen is diagnosed with a cardiovascular complication, a decade of opportunity for prevention and intervention has already been lost. The EU Safe Hearts Plan is our chance to stop the domino effect through which obesity and diabetes lead to cardiovascular disease - turning a fragmented system into pillar of resilience for EU’s economy, health systems and its people. For too long, we have addressed interconnected health challenges through siloed approaches.

We cannot fix cardiovascular health in Europe while ignoring obesity and diabetes. Protecting the heart requires earlier action on metabolic conditions - before they progress into serious cardiovascular events.

Preventing the domino effect: Why we must address the obesity-diabetes-CVD nexus

The science is clear, but policy has not kept pace. It is time for policy to move beyond siloed approaches to cardiovascular care and adopt an integrated, whole-person approach. Individuals at risk of cardiovascular disease often live with obesity and diabetes; if these interconnected conditions are not addressed through coordinated prevention and treatment strategies, the risk of adverse cardiovascular outcomes increases significantly.

Obesity and diabetes are closely linked: the risk of developing type 2 diabetes (T2D) is seven times higher among people living with obesity. People with T2D face a two-three higher risk of heart attack and stroke^[1] and two in three obesity-related deaths are linked to cardiovascular disease^[2]. Early detection, prevention, and management of diabetes and obesity can therefore directly reduce cardiovascular risk.

For years, health policy has operated in silos: heart disease is addressed in one space, diabetes in another, and obesity is still too often framed as a lifestyle choice rather than recognised as a chronic disease. This fragmentation is both a human and an economic failure. Obesity and diabetes are the drivers to other major chronic conditions undermining workforce participation and productivity.

The economic case: Return on investment beyond a treatment-focused model

Policy makers  have the opportunity to position the EU Safe Hearts Plan as a cornerstone of the EU's long-term economic resilience.

The lack of integration represents a major fiscal leak, as diabetes, obesity and their associated complications cost the EU around €240 billion each year in healthcare expenditure and lost productivity[3] - resources that continue to drain from Europe’s economy through avoidable costs and lost working years. At the same time, real-world examples in Europe show a clear return on investment from implementing integrated health checks that bring together key tests for CVD, obesity and diabetes in primary care. Concretely, the UK’s NHS model shows a return of €3.43 for every €1 spent - a figure no finance minister can afford to ignore as this is one of the few policy levers with a proven 3x return[4].

In Ireland, the implementation of the Chronic Disease Management Programme (CDMP) reduced emergency visits by 30% in its first years[5]. This shows that hospital overcrowding can be reduced by strengthening earlier intervention and coordinated chronic disease management, preventing avoidable emergency department visits.

Greece further demonstrates that EU investment can translate preventive approaches into population-wide practice. Its 2025 Prolamvano programme[6], backed by €200 million from the EU Recovery and Resilience Facility,  offers free cardiometabolic health checks to adults aged 30 to 70 and has already reached over 1.8 million citizens[7]. Since September 2025, the programme has expanded to include obesity treatment for adults and children, directly linking screening to care.

From silos to synergies: The Safe Hearts Plans as a new policy blueprint

The EU Safe Hearts Plan should serve as the connective framework linking these conditions into a coherent prevention strategy. If health checks focus only on blood pressure while overlooking BMI and glucose levels, we are addressing the warning signs without tackling the underlying causes.

We must move beyond single-condition screenings. Integrated health checks are essential to identify and respond to the Obesity-Diabetes-CVD nexus. The UK’s NHS Health Check model, for example, does not focus solely on cardiovascular risk; it assesses the broader metabolic pathway. The result has been a 23% reduction in cardiovascular mortality and projected savings of up to €70 billion. [8][9]

The estimated annual loss of €240 billion from obesity and diabetes-associated complications across the EU is a stark reminder of the cost of intervening too late. Unchecked, obesity and diabetes do not stay contained. They drive a domino effect that can affect multiple organs, including the heart, kidneys, liver, and brain[10]. Building a model of economic and health-system resilience therefore requires recognising that prevention and early detection is our most effective tool to halt this trajectory before it begins.

To achieve this, we must strengthen primary care as the central hub of Europe’s health strategy, improving prevention, early diagnosis and the integration of care across the cardio-metabolic continuum. This would shift the focus from managing late-stage illness to actively extending the healthy, productive years of European citizens.

The bold path forward: Aligning political will with science

If the EU is to strengthen health resilience effectively, it must act decisively to end the systemic fragmentation that currently undermines our efforts to reduce cardiovascular diseases.

This transition should begin with health initiatives that place obesity and diabetes checks at the center of any cardiovascular - or broader cardio-metabolic - strategy. Aligning health checks with robust scientific evidence requires formally recognising obesity and diabetes as key determinants of cardiovascular disease - an essential step towards reducing stigma and enabling the structured, long-term care pathways patients deserve. Embedding structured weight management within diabetes care strategies, and recognising obesity as a chronic disease, will support coordinated care pathways, improve access to treatment, and strengthen multidisciplinary care.

The bottom line: Europe cannot protect the heart without addressing diabetes and obesity. The EU Safe Hearts Plan is a unique opportunity to stop the first domino from falling.

For further information about the interconnectedness of obesity and diabetes and experts' recommendations, please refer to the event report from the IDF-E event on “Addressing the growing burden of Diabetes and Obesity: Integrated Strategies for Prevention, Better Health Outcomes and Improved Quality of Life” organised on 29 January in the European Parliament with support from the EFPIA Obesity Platform.

References:

[1] Two-page-graphic-Safe-Hearts

[2] Martin-Timon I, Sevillano-Collantes C, Segura-Galindo A, et al. Type 2 diabetes and cardiovascular

disease: Have all risk factors the same strength? World J Diabetes. 2014;5:444-470; Collaborators GBDO, Afshin A, Forouzanfar MH, et al. Health Effects of Overweight and Obesity in 195  Countries over 25 Years. N Engl J Med. 2017;377:13-27

[3]  EUDF. Diabetes Community Pledge (2024). Available here. [Accessed 09 February 2026]

[4] Office for Health Improvement and Disparities. Review of the NHS Health Check: Annex E: Health economic modelling (2021). Available here.

[5] Health Service Executive. Chronic Disease Management Programme in General Practice: Impact Report (2025). Available here. [Accessed on 15 April 2026].

[6] European Commission. National public health prevention programme “Cardiovascular risks prevention (n.d.). Available here.

[7] Athens Time. (2025). Available here. [Accessed 17 April 2026]

[8] McCracken, C., Raisi-Estabragh, Z., Szabo, L. et al. NHS Health Check attendance is associated with reduced multiorgan disease risk: a matched cohort study in the UK Biobank. BMC Med 22, 1 (2024). Available here.

[9] Ismail, Hanif, and Karl Atkin. “The NHS Health Check programme: insights from a qualitative study of patients.” Health expectations : an international journal of public participation in health care and health policy vol. 19,2 (2016): 345-55. doi:10.1111/hex.12358

[10] Selman A, Burns S, Reddy AP, Culberson J, Reddy PH. The Role of Obesity and Diabetes in Dementia. International Journal of Molecular Sciences. 2022; 23(16):9267. Available here.