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

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.