Quick Dive: Heat extremes and cardiovascular diseases

What is the reason for and aim of the publication?

Rising global temperatures are increasingly affecting public health, particularly among individuals with cardiovascular disease (CVD), who are significantly more vulnerable to heat-related morbidity and mortality. This scientific statement was developed by an interdisciplinary task force of the European Society of Cardiology (ESC) associations, councils and working groups to address this urgent issue. Despite substantial epidemiological evidence linking heat exposure to cardiovascular events, there remains a gap in understanding the physiological mechanisms underlying this relationship. Moreover, existing public health strategies have proved insufficient in mitigating risks, especially for vulnerable populations.

This publication aims to synthesise current scientific knowledge on the effects of heat on cardiovascular health, encompassing epidemiology, human thermophysiology, pathophysiological mechanisms, and social determinants of health. It also explores the compounding effects of air pollution and inequities in infrastructure and access to care. Importantly, the statement provides a forward-looking research agenda, urging the scientific community to address evidence gaps and develop targeted, equitable interventions to reduce the burden of climate-related cardiovascular harm.

What are the most important take-home messages?

1. Heat extremes pose a serious, growing threat to individuals with CVD, particularly older adults and those with limited socioeconomic resources.
2. The pathophysiological mechanisms of heat-related cardiovascular strain include dehydration, inflammation, myocardial stress, and impaired thermoregulation, often exacerbated by medications and comorbidities.
3. Public health systems and clinical care are currently underprepared, highlighting the urgent need for evidence-based, inclusive strategies to mitigate these risks amid a warming climate.

What are challenges in practical implementation – and possible solutions?

Practical challenges include poor access to cooling strategies, limited awareness among vulnerable populations, and insufficient integration of heat-health considerations into clinical guidelines. Financial constraints also deter the use of air conditioning, especially among the elderly. Public health messaging is often generic and lacks clinical specificity. To address these barriers, cost-effective solutions like public cooling centres, personalised cooling strategies (e.g. fan use), and climate-adapted care guidelines are recommended. Cross-sectoral collaboration between health, urban planning, and social services is essential to ensure equitable and scalable interventions.

Which issues still need to be tackled, that are not yet addressed by the paper?

While the paper outlines key physiological risks and social vulnerabilities, it does not give hand-on guidance on how to reduce the impact of heat extremes on cardiovascular health. This will be addressed in a related ESC statement that is currently in progress.

What further developments on the topic are emerging?

The research agenda calls for interdisciplinary studies to clarify why individuals with cardiovascular disease (CVD) are at heightened risk during heatwaves and extreme heat. It highlights the urgent need for robust, empirical evidence on the physiological effects of heat, particularly outside the context of heatstroke. Priorities include developing targeted interventions, addressing healthcare access in low- and middle-income countries, and understanding how medications influence cardiovascular outcomes during heat exposure. Additionally, it advocates for the integration of digital health tools and equitable, sustainable strategies to reduce health disparities and build resilience in vulnerable populations.

Scientific statement: "Heat extremes and cardiovascular diseases"

Reference: Chaseling GK, Uchmanowicz I, Bäck M et al. Heat extremes and cardiovascular diseases: a scientific statement of the Association of Cardiovascular Nursing & Allied Professions, Association for Acute Cardiovascular Care, European Association of Preventive Cardiology, Heart Failure Association, European Heart Rhythm Association of the ESC, the ESC Council on Hypertension, the ESC Council on Stroke, and the ESC Working Group on Cardiovascular Pharmacotherapy. European Heart Journal, ehaf326, https://doi.org/10.1093/eurheartj/ehaf326.

Document types published by the ESC, Associations, Councils, Working Groups, and ESC Committees (according to the ESC Scientific Documents Policy):