Temperature-Attributable Cardiovascular Mortality in Europe Under Future Climate Scenarios: Projected Impacts of Population Aging and Climate Change to 2080.

Abstract

Aims: Heat and cold stress are established cardiovascular risk factors. As climate patterns shift and Europe's population ages, quantifying their separate attributable fractions-and projecting future temperature-attributable cardiovascular disease (tCVD) burden-is essential for clinical and policy decision-making.

Methods: Europe was divided into a 0.25° × 0.25° grid (12,411 land cells across 37 countries). Annual cardiovascular disease (CVD) deaths (2016-2023) were downscaled from national estimates using population data. Temperature-mortality relative risk coefficients were drawn from a 27-country pooled study and applied via population attributable fractions with 1,000 Monte Carlo simulations. Daily mean temperature projections from five bias-corrected climate models were obtained under moderate (SSP2-4.5) and high (SSP5-8.5) emission scenarios. Population aging was incorporated using country-level age projections; climate-only analyses held age structure constant at 2020 levels.

Results: At baseline, non-optimal temperature accounted for 168,586 [144,961-192,293] CVD deaths annually (31.4 [27.0-35.8] per 100,000), with a cold-to-heat ratio of 5:1. Under SSP5-8.5, total tCVD mortality is projected to nearly double to 62.4 [48.5-76.2] per 100,000 by late-century (441,772 [343,627-540,116] annual deaths), with heat-attributable rates projected to rise 472%. Population aging may amplify total projected mortality by over 80% by late century beyond climate change alone; without aging, cold-attributable rates may decline over the century rather than rise.

Conclusions: tCVD mortality across Europe is projected to double by late-century, driven by dramatic heat increases and substantially amplified by population aging. These findings support greater integration of temperature-related CVD risk into clinical practice and public health policy.