Introduction
Coronary heart disease (CHD) remains a leading cause of death and disability worldwide. Over the last decade European Society of Cardiology (ESC) guidance has moved toward more ambitious preventive goals—lower LDL-C, tighter blood-pressure control, broader use of cardioprotective glucose-lowering drugs, and strong endorsement of structured cardiac rehabilitation (CR). The EUROASPIRE programme has repeatedly measured how far routine care keeps pace with those recommendations. The latest iteration, EUROASPIRE VI (Wood et al., 2026), is the largest contemporary snapshot: 8,590 patients across 160 hospitals in 27 countries (September 2024–February 2026). It provides sobering evidence about what guideline-concordant care actually looks like in the real world.
Why this matters now
– ESC prevention recommendations set ambitious, evidence-based targets intended to reduce recurrent events in people with established CHD.
– Cardiac rehabilitation, long recognized as essential secondary prevention, now features in ESC workstreams as an implementation priority.
– EUROASPIRE VI demonstrates persistent shortfalls in risk-factor control and highly variable CR access and uptake—especially in the highest cardiovascular risk regions in Europe—highlighting an “inverse care” problem: where need is greatest, delivery is poorest.
