Cardiovascular risk and prevention strategies in populations affected by war: lessons from Ukraine

Background Armed conflict is recognized as a major disruptor of non-communicable disease prevention, dramatically affecting patient outcomes and continuity of care for chronic cardiovascular conditions. War-related stress, displacement, and fragmentation of healthcare infrastructure amplify cardiovascular (CV) risk due to both loss of access to preventive services and heightened psychosocial burdens. Since the 2022 escalation of conflict, Ukraine exemplifies these challenges, suffering from mass internal displacement and recurrent attacks on medical infrastructure. However, systematic evaluation of pragmatic responses in preventive cardiology remains limited, underlining the need for evidence-based guidance. Purpose This study assessed changes in cardiovascular risk management amidst conflict and identified adaptive strategies for the sustainability of preventive care in Ukrainian war-affected regions. Methods A mixed-methods design was implemented, integrating quantitative analysis of regional health data (2022–2025) from war-affected regions with semi-structured interviews of 112 primary care physicians engaged in primary and secondary prevention. Utilizing a systems framework, analysis explored determinants spanning patients, providers, and health system structures. The study specifically addressed supply chain breakdowns, workforce shifts, and digital health adoption. Results Hypertension control rates dropped by an estimated 25% in 2022, closely associated with disruptions to medication supply, migration of specialized staff, and diminished diagnostic capacity. Surveyed professionals described high levels of patient mental distress, impaired treatment adherence, and exacerbated cardiovascular risk among displaced populations. In response, task-shifting of preventive counseling to primary care providers, implementation of telemedicine for follow-up, and targeted community screening in shelters and evacuation centers were rapidly introduced. Despite technological and infrastructural barriers, the adoption of telemedicine models provided critical continuity of care for select at-risk groups. By mid-2024, partial restoration of preventive services was achieved through decentralized care networks, supported by local innovation and international aid partnerships. Conclusions Populations affected by war face a compounded CV risk burden, driven by both psychosocial stressors and systemic barriers to care. The Ukrainian context demonstrates that community-oriented, flexible prevention models – integrating mental health and cardiovascular services, expanding the role of non-physician health workers, and leveraging telemedicine – can sustain preventive cardiology during protracted crises. These findings underscore the importance of preparedness planning and adaptability in European frameworks for preventive cardiology, advocating for systems-level resilience to protect cardiovascular health during armed conflict.