Exploring Tobacco Usage and Cardiovascular Disease in Switzerland

By:Ethan Bleich & Sunishka Gowda

I. Introduction

According to global statistics, Cardiovascular disease (CVDs) causes 1 in 3 deaths worldwide, with an estimated 17.9 million lives taken every year [1]. CVDs refer to a broad range of conditions that involve the heart and the blood vessels, components that are involved in the functioning of the cardiovascular system. Disorders can include (but are not limited to) coronary heart disease, cerebrovascular disease, rheumatic heart disease and other conditions. CVDs are multifactorial, meaning there are many behavioural risk factors associated with the diseases; for example, lifestyle factors include tobacco use, physical inactivity and environmental factors such as air quality. 

Studies have shown that elderly individuals have a greater predisposition to heart diseases. Moreover, from individual studies by experts, for example, Dr Marta Farrero (head of the Heart Failure Unit at the Hospital Clínic Barcelona), note that heart failure is increasingly common due to an ageing population; however, Swiss health trends suggest that these conditions are not exclusive to the elderly.  

Although mortality rates have improved over the last few decades, heart disease accounts for a large proportion of overall deaths and remains the leading cause for hospitalisation, especially for individuals above the age of 65 [2]. This disease remains a major public health concern in Switzerland due to a combination of high mortality rates among elders, prevalence of specific risk factors, and current healthcare focus prioritising treatment over prevention[3]. Raised health metrics within the Swiss population that contribute to the incidence of major risk factors include cholesterol and obesity with 62.4% of the population having a high cholesterol level and 58.2% adults being considered obese. Other factors include blood pressure and lifestyle choices such as smoking which concerns 28.3% of men and 20.9% of women. 

Societal struggles may also account for challenges in decreasing the rate of NCDs, non-communicable diseases (including CVDs)  in Switzerland. Despite Switzerland spending significantly on healthcare (US $8998 per capita) which accounts for 11.8% of its GDP, Out-of-Pocket payments are higher in Switzerland (23%) compared to EU average (19%) which may create financial barriers to accessing care[4]. The elevated household contributions may prevent services and early treatments, contributing to ongoing heart disease prevalence. Furthermore, although the health workforce is expanding, there are significant concerns regarding the aging of healthcare professionals and a high reliance on foreign-trained doctors. 

Cardiovascular disease represents a significant public health and socio-economic burden in Switzerland as it is a major cause of mortality and contributes to reduced qualities of life and high expenditure on healthcare. According to AMGEN, cardiovascular disease was responsible for more than 21,000 deaths in Switzerland in 2015 and predicted approximately 78,000 fatal and non-fatal cardiovascular events in 2017. These events were associated with more than CHF 3.3 billion in direct costs whilst also creating wider social and economic consequences such as loss of paid world, reduced productivity and unpaid care or support provided by families[5]. 

II. Epidemiology of Heart Disease in Switzerland

Cardiovascular disease represents a major public health concern in Switzerland. According to the European Society of Cardiology, cardiovascular disease accounts for approximately 35% of deaths in Switzerland making it a significant cause for the country’s mortality. The particularly great contributors include stroke and ischaemic heart disease with reported rates being 1,515 deaths per million for ischaemic heart disease and 832 per million for stroke. Switzerland also has a high prevalence of several cardiovascular risk factors due to rising cholesterol levels, high blood pressure, smoking, obesity and diabetes, which all contribute to the burden of CVDs[6] .

Recent data has shown a sex-based trend in CVD mortality as in 2024, cardiovascular diseases was the leading cause of deaths among women in Switzerland, accounting for 29% of female deaths. Whereas for men, cancer is the leading cause of death with CVD only accounting for 27%. While cardiovascular diseases remain major causes of mortality in both sexes, its relative contribution is higher in women[7]. Age is an important factor affecting CVD as in Switzerland, men over the age of 45 and women over the age of 55 are described as being particularly at risk[8]. Variation by region in CVD risk may also be influenced by the environment. Studies have shown that cardiovascular deaths and emergency hospital admissions across seven regions have found that hotter regions generally had higher mortality rates, particularly on those aged 75 and older[9].

Overall, in Switzerland, cardiovascular mortality has declined over time, especially for coronary heart disease and stroke. Population-based studies have shown that Swiss mortality from 1995 to 2018 for CHD and stroke has decreased across both sexes and in all age groups. Mortality from CHD and stroke (combined) has dropped from 208 to 75 per 100,000 individuals among men and from 112 to 43 per 100,000 among women. The decline reflects wider improvements in cardiovascular prevention as treatment and management of risk factors efforts have increased. However, the trend is not strong throughout, as stroke mortality has plateaued from 2012 among men aged 60-74 years and plateaued after 2015 for women in the same age cohort. Although Switzerland has made significant progress, continued prevention efforts however still remain vital, particularly for adults aged 60 and above[10]. 

III. Types of Heart Disease

Coronary artery disease (CAD)  is one of the most common forms of heart disease. It occurs when the coronary arteries cannot supply the heart with sufficient oxygen due to the narrowing of these blood vessels. This is primarily caused by the accumulation of fatty deposits, plaques, within artery walls. The process, known as atherosclerosis develops as a result of damage to the inner lining of arteries which triggers the build-up of lipids, fibrous tissues and calcium salts. Over time, the plaques harden, reducing the elasticity and diameter of blood vessels, thereby reducing blood flow and placing additional strain on the cardiovascular system[11]. In Switzerland, coronary artery disease remains a major health concern as in 2022 20.2% of the population was reported to be affected by the disease[12]. 

Heart failure (HF), also known commonly as congestive heart failure (CHF), is a clinical disorder in which the heart is unable to pump blood effectively enough to meet the body’s oxygen requirements. HF can occur as a result of structural and functional issues interfering with the heart's ability to fill its ventricles and eject blood. [13] While several conditions contribute to the development of HF, Ischemic heart disease, a condition that refers to the reduced blood flow as a result of plaque formations, is considered one of the leading causes. Other significant contributing factors include: hypertension, valvular heart disease and myocarditis[14]. Common symptoms include shortness of breath, fatigue, and edema, which is swelling usually in legs, ankles and feet[14]. As of 2025, heart failure has affected approximately 300,000 people in Switzerland[15].  

Arrhythmias, also known as cardiac arrhythmias, are disorders of the heart’s electrical conduction that causes an irregular heartbeat. They occur as a result of electrical signals which are responsible for the heartbeat failing to function properly resulting in inconsistent heartbeats that are either too fast or too slow. Some forms of arrhythmias can be harmless and occur only temporarily, such as during exercise or sleep but others can lead to serious complications[16]. Most arrhythmias arise due to issues with the heart’s valves, muscles and arteries with causes including, coronary heart disease, high blood pressure and valve disorders. Common symptoms include heart palpitations, fatigue and chest discomfort. Reducing the risk of heart damage that contributes to arrhythmias can be achieved by limited tobacco and alcohol consumption, stopping use of caffeine and avoiding stimulants[17].   

Heart valve disease occurs when one or more heart valves malfunction and do not open or close properly, affecting blood flow. Valves are integral components of the heart function as they keep blood flowing through the heart in one direction. Main types of valvular heart disease include Stenosis, when valves are narrowed; regurgitation, when valves leak and blood flows backward; prolapse, when valves become floppy and do not close tightly; and Artesia, a congenital condition where the valves form without an opening. If left untreated, heart valve disease can place significant strain on the heart and be life-threatening. Treatments include medications, valve repair or replacement surgeries, depending on the severity and type of valve abnormality[18]. 

Congenital heart disease (CHD) refers to structural abnormalities of the heart that are present from birth. These are defects affecting various parts of the heart including the walls, blood vessels or valves and can interfere with blood flow. CHD can vary in severity as some cases are asymptomatic with milder effects while others can be life-threatening. There are two main types of CHD, cyanotic, where oxygen levels are reduced in the blood and acyanotic where blood circulation is abnormal[19]. Symptoms of CHD include, bluish skin or lips, difficulty in breathing, fatigue or an unusually fast or weak heartbeat. Although the exact cause is not always known, CHD may be linked to genetic factors, abnormal fetal development or certain maternal risk factors during pregnancy such as smoking or alcohol consumption[20]. Annually in Switzerland approximately 700 children are born with congenital heart disease[21]. 

IV. Major Risk Factors

Smoking and tobacco use are major lifestyle-based risk factors for heart disease. The thousands of harmful chemicals found in cigarettes, including nicotine, carbon monoxide and oxidants, damage the lining of blood vessels, which triggers inflammation and blood clotting. This increases the development of atherosclerosis, the build-up of plaque that restricts blood flow and raises risk of CVD. Mechanisms such as carbon monoxide's ability to bind to haemoglobin, reducing oxygen transport around the body, increase the likelihood of myocardial infarctions and other cardiovascular diseases. 

Poor diet is a significant factor for cardiovascular disease, particularly when it involves excessive sodium intake and consumption of highly processed foods. High sodium diets are linked with increased blood pressure as it increases the body’s retention to water and as a result can cause hypertension, one of the major contributors to cardiovascular disease [22]. In addition, diets low in fruit and vegetables may also increase cardiovascular risk because these foods provide integral fibres, potassium, magnesium and antioxidants that help reduce blood pressure, improve cholesterol levels and support overall metabolic health. Inadequeate fruit and vegetable consumption has consequently been associated with an increased number of cardiovascular deaths [23]. Diets high in saturated fat can raise total cholesterol and low density lipoprotein cholesterol known as LDL cholesterol. Higher LDL levels can increase the risk of fatty deposits forming in arteries which may narrow blood vessels and contribute to coronary heart disease[24]. Physical inactivity and sedentary behaviour are major risk factors for cardiovascular disease. Physical inactivity refers to the inadequate levels of physical activity that does not reach the recommended level, while sedentary behaviour involves prolonged sitting with very low energy levels. A lack of regular movement can increase the risk of cardiovascular disease as it is often associated with higher blood pressure, reduced metabolism and greater risk of developing conditions such as type 2 diabetes, all of which contribute to increased pressure on the body's cardiovascular system. A sedentary lifestyle can affect blood lipid regulation causing inflammation and oxidative stress, impairing the ability of blood vessels to dilate properly and function overall[25]. For example, prolonged sitting, particularly after meals, is linked  with high glucose and insulin levels increasing the risk of insulin resistance and type 2 diabetes because when muscles are inactive, their demand for blood sugar drops and as a result the body must produce more insulin to manage blood sugar levels[26]. Over time, these changes may contribute to hypertension, coronary artery disease, heart failure and increased cardiovascular mortality. Improving cardiorespiratory fitness and blood vessel function can as a result be achieved by regular physical activity[27].  

Additionally, obesity and metabolic syndrome are also major risk factors for cardiovascular disease. Excessive adiposity, the state of having excessive amounts of body fat, especially visceral fat, can release inflammatory chemicals into bloodstreams due to its metabolically active state. This contributes to inflammation which damages the inner lining of blood vessels, causing the blood vessels to become less able to relax and regulate blood flow. At the same time, obesity also increases oxidative stress meaning there is an imbalance between harmful free radicals and compounds to neutralise them. This further damages blood vessels, making it more prone for the build up of fatty deposits in arterial walls[28]. Obesity is also linked with insulin resistance where the body’s cells respond less effectively to insulin leading to high blood glucose levels and hypertension. Altogether, obesity increases the risk of atherosclerosis and the risk of cardiovascular complications[29]. 

High blood pressure, or hypertension, is a factor increasing the risk for CVD because it places continuous strain on the arteries and the heart. Over time, this pressure damages blood vessels and increases the risk of coronary heart disease, stroke, heart failure and cardiovascular death. Lowering blood pressure can as a result significantly reduce cardiovascular risk showing that hypertension plays a major causal role in CVD [30]. In addition, high cholesterol levels also increase the risk for heart disease because excess LDL builds up in artery walls and forms plaques. The atherosclerosis narrows the arteries and reduces oxygen-rich blood flow to organs such as the heart and brain. If plaques rupture, they can form blood clots that block arteries causing events such as heart attacks[31]. Diabetes also contributes to CVD because high blood sugar and insulin resistance can damage blood vessels over time. People with Type 2 diabetes often are also associated with high levels of triglycerides, obesity, and physical inactivity all of which increase the risk of coronary heart disease. Managing blood glucose, can as a result help reduce cardiovascular health[32].

Genetic factors can play an important role in increasing the risk of cardiovascular disease. A family history of CVD, particularly when it affects close-related families such as parents and siblings can indicate a higher inherited risk. This is because genetic variations such as mutations passed down from parent to child may influence factors of cardiovascular health including blood cholesterol levels, blood pressure, and structure or function of the heart. Cardiac conditions such as arrhythmias, congenital heart disease, and cardiomyopathy can run in the genes of families.  However, genetics alone does not increase susceptibility to heart disease but also through modifiable lifestyle factors such as smoking, diet and physical activity[33].

 Age is another non-modifiable risk factor for CVD as the risk of developing cardiovascular conditions increases as a person grows older due to long-term changes in the heart and blood vessels as well as the accumulation of other risk factors such as hypertension, diabetes and atherosclerosis. According to the national library of medicine, published in March 2022, 40% of the global CVD deaths were among people aged 70 years and older[34]. Older adults also have a more likelihood of experiencing several chronic conditions all of which worsen quality of life[35]. 

V. Prevention Strategies

Primary care physicians are the main orchestrators of smoking cessation efforts in patients in Switzerland. PCPs provide cost-saving interventions to reduce the burden of tobacco in the population. Swiss recommendations for prevention in primary care strongly advocate for tobacco use and delivering proven interventions. As access to cessations in Switzerland is vast, there are various methods available to individuals attempting to quit, and medications like varenicline, bupropion, and combination NRT can double the chances of quitting smoking[36]. The Swiss Association for Tobacco Control takes measures such as denormalization of tobacco consumption, and youth protection from initiation to keep addiction to a low. Included in the denormalization of tobacco use is popularization of tobacco products that offer lower-risk alternatives to smokers who do not want to give up tobacco use. This decreases the likelihood of developing CVDs for both first and second hand consumers of tobacco fumes[37]. 

The Federal Food Safety and Veterinary Office of Switzerland’s approach to dietary recommendations is holistic with prioritization on the consumption of fresh, healthy foods, an active lifestyle sustainability[38]. The Mediterranean diet is also recommended for heart health. The University Hospital of Geneva recommends avoiding trans fat and overconsumption of salt, as it may harden arteries and increase blood pressure[39]. A variety of healthy protein-rich foods as well as healthy fats and oils can also support heart and arterial health[40]. The Swiss Federal Office of Public Health condones physical activity for heart health and additional health benefits. Regular exercise improves fitness, quality of life, mental well-being, quality of sleep, bone health and helps manage body weight[41]. These lifestyle patterns can significantly reduce likelihood of developing chronic cardiovascular diseases, and from suffering major cardiac events. 

Access to screening is broad in Switzerland with a variety of cardiology specialists available. Checkups are performed regardless of risk factors but simply based on patient desire or depending on the state of the patient. However, basic insurance typically does not cover the cost of these checkups, but are often partially covered by supplementary insurance. During screening, blood samples and blood pressure measurements are taken, and an echocardiogram is performed to check cardiovascular function. For a more thorough checkup, when there is suspicion of cardiovascular disease, lung function and an ultrasound of the carotid artery as well as imaging of the heart are in order[42].

VI. Smoking and Cardiovascular Health

Tobacco smoke contains thousands of harmful chemicals such as nicotine, carbon monoxide and oxidants which can damage the lining of blood vessels and disrupt normal cardiovascular function. The damage to blood vessels can contribute to an inflammatory response and increased blood clotting which promote the development of atherosclerosis, a condition in which plaque build-up reduces blood flow to the heart and increases the risk of coronary heart disease. Chemicals like carbon monoxide bind to haemoglobin reducing the transport of oxygen around the body. As a result in order to combat this, the body increases heart rate placing additional strain on the cardiovascular system. Because of these effects, tobacco use is considered one of the most preventable causes of cardiovascular disease[43].   

Smoking and tobacco can cause CHD through several mechanisms of biological damage. For example, cigarette smoke causes oxidative stress and reduces nitric oxide availability, a key  antioxidant which neutralises free radicals. When nitric oxide levels drop, blood vessels are as a result more prone to damage caused by free radicals[44]. Smoking also increases oxidative modification of low-density lipoproteins (LDLs), increasing lipid deposition in the vessel walls and eventual plaque development. Over time, these plaques narrow the coronary arteries and reduce the supply of oxygen-rich blood to the heart muscle. In addition, smoking further increases the risk of thrombosis by activating platelets, triggering the coagulation system and reducing the body ability to break down fatal clots[45].   

Secondhand smoke increases the risk of cardiovascular diseases as passive exposure can affect the heart and blood vessels even in people who do not actively smoke. The harmful chemicals in tobacco smoke can cause damage to the endothelium, increase inflammation and promote blood clotting all of which trigger the process of atherosclerosis, where plaque build up increases the risk of CVDs. Evidence suggests that brief exposure to smoke, including second hand smoke can also have similar effects as similar impacts such as activating platelets and stimulating coagulations. Furthermore, according to studies conducted by the European Society of Cardiology, secondhand smoke increases the risk of atrial fibrillation, a potentially serious heart rhyme disorder. Risk increases as the duration of passive smoke exposure becomes longer, suggesting a relationship that depends on scale[46]. 

Smoking overall remains an important public health concern in Switzerland, as an official survey conducted from 2012 to 2015 suggested that around 25% of the population smoked. Although this is a low value compared to the Europe-wide average, a Swiss study conducted suggested a large discrepancy between reported smoking and estimated actual cigarette consumption. Data suggests that more than 9000 deaths each year in Switzerland are caused due to tobacco-related illnesses. If smoking numbers are underestimated, policymakers may also likely underestimate the need for stronger tobacco control measures as the true number for cigarette consumption is sought to be over 31%[47].  

VII. Diagnosis and Treatment

The initial step during suspicion of heart disease is an echocardiogram (ECG). Coronary heart disease may appear on an ECG as flattened T waves or elevated ST segments, indicating a lack of blood flow to heart, however further tests would be needed immediately to rule out other diseases[48].

Diagnosis of coronary heart disease is done primarily through non-invasive imaging techniques to provide information about the structure of the heart and arteries. A technique called nuclear medicine allows cardiologists to visualize a slightly radioactive substance called tracer which acts as a visual contrast in the myocardium allowing physicians to assess any scarring or ischaemia in the myocardium, or arterial plaque buildup. This process is known as SPECT or PET, which is simply radiological 3D imaging similar to a CT scan. The advantage this process has over a CT scan is the ability to assess myocardial perfusion; the blood flow to the arteries from the heart[49]. 

Drug treatment of coronary heart disease is aimed at halting the progression of the disease and reducing the intensity of the symptoms. Anticoagulants, also known as platelet aggregation inhibitors, reduce the risk of blood clots forming in the coronary arteries, reducing risk of heart attacks[50]. Beta Blockers reduce blood pressure and heart rate, reducing the likelihood of cardiovascular disease and recurring events in patients that have already experienced a cardiovascular event. Statins are typically prescribed to reduce cholesterol presence to lower the likelihood of arterial diseases or cardiovascular events[50]. 

Bypass surgery is an operation that allows blood to flow to the heart by creating a passageway around obstructed arteries. The procedure uses existing arteries from the patient’s chest wall, forearm, or leg to create the new passage. This new connection allows blood to flow into the heart containing the intended oxygen level[1]. Angioplasty on the other hand, is a minimally invasive procedure that allows blood to flow through coronary arteries more easily by inflating a balloon at the end of a catheter to expand the artery. The procedure can be performed in an emergency such as a heart attack, or during suspicion of heart disease[51]. Following the deflation of the balloon, a stent is typically placed in the artery to keep it open long term. The stent typically releases a medication slowly that prevents the renarrowing of the artery[52]. 

Cardiac rehabilitation is a necessary step that further improves quality of life beyond medication after a cardiovascular event. In Switzerland, this process occurs in 3 phases. The first phase is early mobilization in the hospital, where the end goal is simply to get the patient physically active and psychologically well as soon after the event as possible. The next phase is outpatient rehabilitation, which is 4 to 12  weeks of physician supervised physical activity, nutritional counseling, and other preventative measures. The goal of this is to create lasting lifestyle adjustments to prevent future cardiac events. The final phase is long term rehabilitation, where patients can participate in a cardiac support group to remain healthy, remain held accountable by other rehabilitants, and exchange experiences with those who have suffered similar events[53]. 

VIII. Healthcare System Response in Switzerland

Switzerland varies from many nearby European countries in not having a universal healthcare system. Thus, both ambulatory primary physicians and specialists tend to work independently even within hospitals. This leaves patients unrestricted in their access in emergent events if affordability is not an issue [54]. In events of generally suspected cardiovascular issues, patients are able to access a specialist without need for a referral from a primary care physician. 

Primary care is very important to locate and diagnose medical conditions without having to consult a specialist, while building a relationship with a physician who has a full scope of the patient. General practitioners in Switzerland offer a large range of services, including diagnosis and follow-up for chronic conditions[55]. Cardiovascular prevention in Switzerland is primarily based on secondary prevention programs taking place in cardiac rehabilitation centers, however a heavier emphasis on primary prevention provided by practitioners is necessary[3]. 

There is no free public healthcare in Switzerland, and private health insurance is mandatory for all residents. The most basic coverage option through the Swiss healthcare system covers most typical treatments, prescriptions, maternity, and accidents, however more complex conditions may not always be covered[56]. It was found that patients with supplemental coverage were consistently more likely to receive cardiovascular care than patients with the most basic insurance policy[57]. 

IX. Public Health Policies and Initiatives

Since 2010, there has been a partial ban on smoking in Switzerland, covering workplaces and public indoor spaces. In 2012, the Swiss people voted against stricter smoking regulations which were targeted at improving public health[58]. The purchase of tobacco products is limited to 18 years of age in every Swiss canton. The Federal Law on Tobacco Products went into effect in 2024, limiting advertising and sale of tobacco products as well as aiming to protect people from passive smoking at the national level instead of cantonal[59]. Additionally, the “Tabakpräventionsfond” or tobacco-prevention-fund promotes a tobacco and nicotine free Switzerland[60]. 

Public awareness campaigns are increasing in prevalence in Switzerland. The Federal Office of Public Health launched the “I am stronger” smoking awareness campaign, which was joined by Swiss cities such Lugano, who offer support to residents seeking to quit smoking[61]. However, anti-smoking initiatives still fall behind most European countries. Switzerland ranks second-to-last on both the European Tobacco Control Scale, which evaluates the implementation of prevention policies, and the Global Tobacco Industry Interference Index, which measures the industry’s influence over legislation. Additionally, Switzerland has not yet ratified the WHO Framework Convention on Tobacco Control, adopted by 183 countries[62].   

X. Challenges and Gaps

15% of all deaths in Switzerland are caused by tobacco-related illness[63]. 1.7 million adults in Switzerland smoke regularly, making up 19.7% of the population. Smokeless tobacco usage consists of snus, chewing tobacco, gutkha, etc. and has a prevalence of 2.10% of the population aged 15+. 3.96% of youth aged 10-14 in Switzerland smoke regularly[14]. However, the most concentrated demographic of nicotine product consumption is age 18 to 24, with approximately 45% of these young people consuming tobacco products[65]. Age restrictions and taxes on tobacco products disincentivize their consumption, but are less effective than intended.

Long-term behavior and habits make reducing tobacco-related cardiovascular disease a challenge. Nicotine is highly addictive and drives dependence making it difficult for smokers to quit[66]. This increases the likelihood of a person that tries smoking to become addicted. Additionally, very few tobacco users can successfully quit the habit in their first attempt[67]. This emphasizes that individual efforts to quit smoking are insufficient, and that professional rehabilitative infrastructure needs to be put in place to help addicts protect their health and the health of others. Similarly, the World Health Organization describes tobacco addiction as “a chronic medical condition requiring repeated intervention and multiple attempts to quit”[68]. Investing in the resources to help addicts is important because smoking cessation is one of the most important actions people who smoke can take to reduce their risk for CVD[2]. 

Nicotine is a major industry in Switzerland, with the largest cigarette company in Europe, Philip Morris International Inc, having a branch located there[69]. This presents a major challenge with regulating and preventing tobacco usage, as taxation and legal restrictions on the production of nicotine products would drive out the manufacturers and decrease economic output. The tobacco industry is estimated to contribute over $6billion a year, and ll,000 jobs, to the Swiss economy[70]. The position this puts the Swiss government in is the reason for lax prevention mechanisms, fueling higher rates of addiction and illness.  

XI. Future Directions and Recommendations

 Strengthening tobacco control policies is important because tobacco use remains one of the most preventable risk factors for cardiovascular diseases. Effective tobacco control requires a clear approach including smoke-free laws, health warnings, advertising bans and increased taxation on tobacco-based products. Although global progress has been made, gaps still prevail, particularly in areas such as cessation support, advertising restrictions and smoke-free legislation. These measures are relevant for Switzerland because stronger tobacco control could help reduce smoking rates, limit second-hand smoke exposure and lower the long-term burden of cardiovascular diseases. Public health policies such as graphic health warnings, higher tobacco taxes and greater restrictions can reduce the appeal of smoking and encourage cessation, protecting future generations from tobacco addiction[71]. 

Integrating lifestyle medicine into routine care is vital as many cardiovascular risk factors are linked to daily behaviours including diet, physical activity, sleep, stress, smoking and alcohol usage. Lifestyle medicine is a branch that involves the focus on lifestyle interventions to prevent and reduce the risk of obtaining a chronic disease rather than only treating symptoms[72].  For example, in application this means healthcare professionals should regularly assess and manage patients’ lifestyle habits and provide practical support where change is required. This includes improving nutrition, physical activity, avoiding tobacco and managing stress. This approach can be strengthened through primary care, as GPs, often the first point of contact, can help identify risk factors early. Therefore, integrating lifestyle medicine into routine care could help reduce cardiovascular risk, improve long-term health outcomes and shift healthcare from reactive treatment towards prevention[73].

An essential approach when reducing the burden of cardiovascular disease on Switzerland is targeted interventions for high-risk populations. This involves different prevention strategies depending on the level of risk an individual has. For example, for conditions such as dyslipidaemia, which is the abnormal number of lipids in the blood, newly introduced prediction tools such as SCORE2 and SCORE2-OP assess long-term CVD risk and include the outcomes of non-fatal myocardial infarction, stroke and mortality due to CVD. These technologies help identify high-risk patients earlier and provide more specific interventions. Programmes such as lipid-lowering treatment for patients after myocardial infarctions are highly recommended, especially when paired with combination therapy such as cholesterol-lowering agents[62]. 

Continued investment in prevention and education is essential for reducing cardiovascular disease in Switzerland, particularly because health outcomes are not determined by medical treatment alone. A Swiss cohort study of patients with coronary syndromes found that individuals with lower educational levels had a higher burden of cardiovascular risk factors, including obesity, smoking, diabetes and hypertension. Although medical therapies were prescribed equally among educational levels, disparities remained in prevention-related behaviours. Patients with lower education levels were less likely to stop smoking and less likely to reach long-term LDL cholesterol targets. These findings suggest that Switzerland should continue investing heavily in education and target follow-up programmes. Measures such as these could help reduce inequalities in CVD outcomes and improve long-term prevention, particularly among socially or educationally disadvantaged groups[74]. 

XII. Conclusion

Cardiovascular disease remains one of the most prevalent public health issues worldwide, and in Switzerland, one-third of deaths in the nation. Despite a drastic improvement in the prevalence of the disease, it remains disproportionately common due to modifiable factors relating to lifestyle habits. Controlling diet, physical activity, obesity, and usage of tobacco products has the potential to drastically reduce the portion of the population dying from cardiovascular disease. Despite high success rates in diagnosis, treatment, and cardiac rehabilitation, the primary issue at hand is the risk posed by unhealthy lifestyle habits. Without promoting measures to reduce access to unhealthy foods and tobacco products, rates of illness will be unable to decrease. Switzerland has high-quality programs in place for nicotine addicts to recover and rehabilitate, with the aim of reducing the number of nicotine addicted individuals and reducing rates of tobacco-related illnesses. 

Many major cardiovascular disease risk factors are modifiable lifestyle behaviours, including smoking, diet, lack of physical activity and obesity. This makes prevention achievable through lifestyle changes. One of the most prevalent yet preventable causes of cardiovascular disease is smoking. Tobacco damages blood vessels, leads to atherosclerosis, and increases blood clotting, all of which increase the risk of heart attack and stroke. Healthy dietary habits can significantly lower the risk of developing cardiovascular disease by lowering blood pressure and improving metabolism, which lowers cholesterol and obesity. Physical activity also improves cardiovascular health by improving blood vessel function and lowering blood pressure, as well as lowering risk for diabetes and heart disease. These lifestyle choices reduce national healthcare costs by reducing hospitalizations from CVDs, which is particularly important to Switzerland due to its high government expenditure on healthcare, and a generally aging population. 

One global takeaway from Switzerland’s cardiovascular health situation is that exceptional healthcare services are not sufficient to prevent large portions of a population from acquiring chronic diseases. Despite high government expenditure on healthcare and medical services, cardiovascular disease is still one of the leading causes of death in Switzerland. This is due to a high dependence on tobacco products within the population and insubstantial efforts to limit the sale of these products. The decline in Switzerland’s deaths from cardiovascular disease is due to improvements in treatment while simultaneously managing risk factors. Primary care physicians and external counselling play a strong role in limiting the likelihood of developing a disease if tobacco dependence has been identified as a potential risk factor. Additionally, cardiac rehabilitation programs offer long-term support for patients recovering from a cardiac event or heart disease diagnosis through lifestyle changes, counselling, and support from others with similar experiences. Continually high smoking rates show how imperative adopting tighter public health regulations on tobacco control are, as well as improving general education of the risks of smoking and increasing access to cessation programs alongside medical care. 

References

[1] Department of Cardiac Surgery, University Hospital Zurich. Bypass surgery for diseased coronary arteries. USZ. Accessed May 2026. https://www.usz.ch/en/department/cardiac-surgery/service/bypass-surgery-for-diseased-coronary-arteries

[2] Federal Statistical Office. Cause of death statistics 2023. Federal Statistical Office. Published December 16, 2024. Accessed May 2026. https://www.bfs.admin.ch/bfs/en/home.gnpdetail.2024-0101.html

[3] European Association of Preventive Cardiology. EAPC Country of the month: Switzerland. European Society of Cardiology. Published October 2016. Accessed May 2026. https://www.escardio.org/communities/associations/eapc/Advocacy/prevention-in-your-country/switzerland/

[4] World Health Organization. Health systems in action: Switzerland. WHO. Accessed May 2026. https://eurohealthobservatory.who.int/docs/librariesprovider3/publicationsnew/switzerland---hsia-one-pager.pdf?sfvrsn=d64dbc37_1

[5] Peter, R., et al. Economic impact of cardiovascular disease in Switzerland. ISPOR Europe. Published November 2019. Accessed May 2026. https://www.ispor.org/docs/default-source/euro2019/ispor-europe-2019-economic-impact-switzerland-peter-pdf.pdf

[6] European Society of Cardiology. Prevention in your country: Switzerland. European Society of Cardiology. Published October 2016. Accessed May 2026. https://www.escardio.org/communities/associations/eapc/Advocacy/prevention-in-your-country/switzerland/

[7] Swissinfo. Cardiovascular disease is the leading cause of death. Swissinfo. Published 2024. Accessed May 2026. https://www.swissinfo.ch/eng/various/cardiovascular-disease-is-the-leading-cause-of-death/90683162

[8] University Hospital Zurich. Coronary heart disease. University Hospital Zurich. Published March 2024. Accessed May 2026. https://www.usz.ch/en/disease/coronary-heart-disease/

[9] Vaucher, J., et al. Cardiovascular prevention in Switzerland: Challenges and opportunities. Swiss Medical Weekly. Published 2021. Accessed May 2026. https://smw.ch/index.php/smw/article/download/3070/5105?inline=1

[10] Sorrentino, L., Chiolero, A., & Carmeli, C. Cardiovascular mortality trends in Switzerland 1995-2018. Eur J Public Health. Published November 2022. Accessed May 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC9713456/

[11] National Health Service. Atherosclerosis. NHS. Reviewed January 2023. Accessed May 2026. https://www.nhs.uk/conditions/atherosclerosis/

[12] Federal Office of Public Health FOPH & Obsan. Cardiovascular Diseases: prevalence (age: 15+) (MonAM indicator). Obsan. Updated November 2024. Accessed May 2026. https://ind.obsan.admin.ch/en/indicator/monam/cardiovascular-diseases-prevalence-age-15

[13] American Heart Association. Risks for and Causes of heart failure. American Heart Association. Reviewed May 2025. Accessed May 2026. https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure

[14] Shams, P., Malik, A., & Chhabra, L. Heart Failure (Congestive Heart Failure). StatPearls. Updated February 2025. Accessed May 2026. https://www.ncbi.nlm.nih.gov/books/NBK430873/

[15] USZ editorial team. Heart Failure – When the heart loses its strength. University Hospital Zurich. Published January 2025. Updated May 29, 2026. Accessed May 2026. https://www.usz.ch/en/when-the-heart-loses-its-strength/

[16] Mayo Foundation for Medical Education and Research. Heart arrhythmia. Mayo Clinic. Published April 2026. Accessed May 2026. https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668

[17] Cleveland Clinic. Arrhythmia. Cleveland Clinic Health Library. Updated April 2026. Accessed May 2026. https://my.clevelandclinic.org/health/diseases/16749-arrhythmia

[18] Cleveland Clinic. Heart valve disease. Cleveland Clinic. Updated December 2024. Accessed May 2026. https://my.clevelandclinic.org/health/diseases/17639-what-you-need-to-know-heart-valve-disease

[19] Cleveland Clinic. Congenital heart disease. Cleveland Clinic. Updated February 2024. Accessed May 2026. https://my.clevelandclinic.org/health/diseases/21674-congenital-heart-disease

[20] National Health Service. Congenital heart disease. NHS. Reviewed December 2025. Accessed May 2026. https://www.nhs.uk/conditions/congenital-heart-disease/

[21] Schwerzmann, M. et al. Challenges of congenital heart disease in grown-up patients. Swiss Medical Weekly. Published September 2017. Accessed May 2026. https://smw.ch/index.php/smw/article/view/2365/3613

[22] Wang, Y., et al. Dietary sodium intake and risk of cardiovascular disease: A systematic review and dose-response meta-analysis. Nutrients. Published September 2020. Accessed May 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC7601012/

[23] Aune, D., et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality: a systematic review and dose-response meta-analysis of prospective studies. International Journal of Epidemiology. Published February 2017. Accessed May 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC5837313/

[24] Victor Chang Cardiac Research Institute. Saturated fats, high cholesterol and heart disease. Victor Chang Cardiac Research Institute. Updated February 2026. Accessed May 2026. https://www.victorchang.edu.au/heart-disease/high-cholesterol/saturated-fat-and-heart-disease

[25] New York State Department of Health. Physical inactivity and cardiovascular disease. Department of Health, New York State. Accessed May 2026. https://www.health.ny.gov/diseases/chronic/cvd.htm

[26] Paing, A., & Chastin, S. Type 2 diabetes: sitting can cause problems with blood sugar levels, so get up and move. The Conversation. Published May 2021. Accessed May 2026. https://theconversation.com/type-2-diabetes-sitting-can-cause-problems-with-blood-sugar-levels-so-get-up-and-move-160391

[27] Liang, Z., Zhang, M., Wang, C., Yuan, Y., & Liang, J. Association between sedentary behavior, physical activity, and cardiovascular disease-related outcomes in adults: A meta-analysis and systematic review. Frontiers in Public Health. Published October 2022. Accessed May 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC9632849/

[28] European Society of Cardiology. Focus on obesity and cardiovascular Disease. European Society of Cardiology. Published January 2025. Accessed May 2026. https://www.escardio.org/education/content-collections/focus/obesity-and-cardiovascular-disease/

[29] Aggoun, Y. Obesity, metabolic syndrome, and cardiovascular disease. Pediatric Research. Published June 2007. Accessed May 2026 https://pubmed.ncbi.nlm.nih.gov/17426660/

[30] Fuchs, F., Whelton, P. High Blood pressure and cardiovascular disease. Hypertension. Published 2020. Accessed May 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC10243231/

[31] Atherosclerosis Australia. Cholesterol and cardiovascular disease. Atherosclerosis Australia. Updated 2026. Accessed May 2026. https://www.athero.org.au/fh/patients/cholesterol-and-cardiovascular-disease/

[32] American Heart Association. Cardiovascular disease & diabetes. American Heart Association. Reviewed April 2024. Accessed May 2026. https://www.heart.org/en/health-topics/diabetes/diabetes-complications-and-risks/cardiovascular-disease--diabetes

[33] Hajar, R. Genetics in cardiovascular disease. Heart Views. Published January 2020. Accessed May 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC7006335/

[34] Zhou, M., Zhao, G., Zhen, Y., Zhu, J., Cheng, F., & Liang, W. Aging and cardiovascular disease: current status and challenges. Reviews in Cardiovascular Medicine. Published April 2022. Accessed May 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC11274005/

[35] Alhindal, M., et al. Impact of smoking on cardiovascular health: Mechanisms, epidemiology and specific concerns regarding congenital heart disease. International Journal of Cardiology Congenital Heart Disease. Published April 2025. Accessed May 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC12002829/

[36] Huguenot, M., et al. Use of nicotine products and tobacco cessation in Swiss primary care: Cross-sectional data from the Sentinella network. Preventive Medicine Reports. Published March 2025. Accessed May 2026. https://doi.org/10.1016/j.pmedr.2025.103013

[37] Addiction Switzerland. What we do. Addiction Switzerland. Accessed May 2026. https://www.at-schweiz.ch/en/about-us/was-wir-tun/

[38] Swiss Federal Food Safety and Veterinary Office. Swiss nutrition recommendations. Swiss Federal Food Safety and Veterinary Office. Updated October 2025. Accessed May 2026. https://www.blv.admin.ch/blv/en/home/lebensmittel-und-ernaehrung/ernaehrung/empfehlungen-informationen/schweizer-ernaehrungsempfehlungen.html

[39] Geneva University Hospitals. Nutrition and cardiovascular health. Geneva University Hospitals. Updated November 2021. Accessed May 2026. https://www.hug.ch/en/elips/nutrition-and-cardiovascular-health

[40] Heart Foundation Australia. Heart-healthy eating pattern. Heart Foundation Australia. Updated May 2026. Accessed May 2026. https://www.heartfoundation.org.au/healthy-living/healthy-eating/heart-healthy-eating-pattern

[41] Swiss Federal Office of Public Health. Physical activity recommendations. Swiss Federal Office of Public Health. Published January 2025. Accessed May 2026. https://www.bag.admin.ch/en/physical-activity-recommendations

[42] Swiss Heart Clinic. Prevention and check-up. Swiss Heart Clinic. Accessed May 2026. https://www.swiss-heart-clinic.com/en/prevention-and-check-up/

[43]. Tobacco and Cardiovascular Disease. Cardiovascular, Respiratory, and Related Disorders. The International Bank for Reconstruction and Development / The World Bank. Published November 2017. Accessed May 2026. https://www.ncbi.nlm.nih.gov/books/NBK525170/

[44] He, H. et al. Nitric oxide acts as an antioxidant and inhibits programmed cell death induced by aluminum in the root tips of peanut (Arachis hypogaea L.). Scientific Reports. Published July 2019. Accessed May 2026 https://www.nature.com/articles/s41598-019-46036-8

[45] Messner, B. & Bernhard, D. Smoking and cardiovascular disease: Mechanisms of endothelial dysfunction and early atherogenesis. Arteriosclerosis, Thrombosis, and Vascular Biology. Published March 2014. Accessed May 2026. https://doi.org/10.1161/ATVBAHA.113.300156

[46] European Society of Cardiology. New evidence links passive smoking with dangerous heart rhythm disorder. European Society of Cardiology. Published August 2023. Accessed May 2026. https://www.escardio.org/news/press/press-releases/New-evidence-links-passive-smoking-with-dangerous-heart-rhythm-disorder/

[47] Wehrli, D., et al. Smoking trends and health equity in Switzerland between 1992 and 2017: dependence of smoking prevalence on educational level and social determinants. Frontiers in Psychiatry. Published November 2023. Accessed May 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC10701586/

[48] NHS. Electrocardiogram (ECG). NHS. Reviewed November 9, 2023. Accessed January 2026. https://www.nhs.uk/tests-and-treatments/electrocardiogram/

[49] Department of Nuclear Medicine, University Hospital Zurich. Clarification of suspected or known coronary heart disease — cardiac imaging (SPECT, PET). USZ. Accessed January 2026. https://www.usz.ch/en/department/nuclear-medicine/service/cardiac-imaging/

[50] Department of Cardiology, University Hospital Zurich. Drug treatment of coronary heart disease. USZ. Accessed January 2026. https://www.usz.ch/en/department/cardiology/service/drug-treatment-of-coronary-heart-disease/  (usz.ch )

[51] Johns Hopkins Medicine. Angioplasty and stent placement for the heart. Johns Hopkins Medicine. Reviewed 2026. Accessed May 2026. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/angioplasty-and-stent-placement-for-the-heart

[52] Mayo Foundation for Medical Education and Research. Coronary angioplasty and stents. Mayo Clinic. Published May 2026. Accessed May 2026. https://www.mayoclinic.org/tests-procedures/coronary-angioplasty/about/pac-20384761

[53] Swiss Heart Foundation. Rehabilitation after heart disease. Schweizerische Herzstiftung. Reviewed 2026. Accessed May 2026. https://swissheart.ch/erkrankungen-und-notfall/leben-mit-der-krankheit/rehabilitation-nach-einer-herzerkrankung/

[54] Peytremann-Bridevaux, I., Burnand, B., Cassis, I., & Nolte, E. Assessing chronic disease management in European health systems: Country reports. European Observatory on Health Systems and Policies / World Health Organization. Published 2015. Accessed May 2026. https://www.ncbi.nlm.nih.gov/books/NBK458747/

[55] T. Cartier, N. Senn, J. Cornuz, & Y. Bourgueil. Building primary care in a changing Europe: Case studies. European Observatory on Health Systems and Policies. Published 2015. Accessed May 2026. https://www.ncbi.nlm.nih.gov/books/NBK459012/

[56] Allianz Care. Healthcare in Switzerland: Understanding the fundamentals. Allianz Care. Accessed May 2026. https://www.allianzcare.com/en/support/health-and-wellness/national-healthcare-systems/healthcare-in-switzerland.html

[57] Struja, T., Suter, F., Rohrmann, S., et al. Comparison of cardiovascular procedure rates in patients with supplementary vs basic insurance in Switzerland. JAMA Network Open. Published January 2023. Accessed May 2026. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800687

[58] Durham, A, Diethelm, P., & Cornuz, J. Why did Swiss citizens refuse a comprehensive second-hand smoke ban? Swiss Medical Weekly. Published July 2014. Accessed May 2026. https://smw.ch/index.php/smw/article/download/1886/2654?inline=1

[59] Swiss Association for Tobacco Control. Federal law on tobacco products one year late. Swiss Association for Tobacco Control. Accessed May 2026. https://www.at-schweiz.ch/en/latest-stories/news/federal-law-on-tobacco-products-one-year-late

[60] Tobacco Prevention Fund TPF. For a Switzerland free from tobacco and nicotine. Tobacco Prevention Fund TPF / Federal Office of Public Health. Published September 2024. Accessed May 2026. https://www.tpf.admin.ch/de

[61] City of Lugano. SmokeFree awareness campaign. Città di Lugano. Accessed May 2026. https://www.lugano.ch/en/la-mia-citta/la-citta-si-racconta/campagne/smokefree/

[62] Geneva University Hospitals. Dyslipidaemia management. Geneva University Hospitals. Published September 2025. Accessed May 2026. https://www.hug.ch/sites/interhug/files/presse/2025.0

[63] Jakob, J., Cornuz, J., and Diethelm, P. Prevalence of tobacco smoking in Switzerland: do reported numbers underestimate reality? Swiss Medical Weekly. Published May 2017. Accessed May 2026. https://doi.org/10.4414/smw.2017.14437

[64] Drope, J., Hamill, S. Secondhand smoke. The Tobacco Atlas.Accessed May 2026.  https://tobaccoatlas.org/factsheets/switzerland/ 

[65] Addiction Switzerland. Tobacco use among young people. Addiction Switzerland. Published February 2025. Accessed May 2026. https://www.at-schweiz.ch/en/knowledge/data-figures/consumption-of-tobacco-among-young-people/tobacco-use-among-young-people/

[66] World Health Organization. Quitting tobacco. World Health Organization. Accessed May 2026. https://www.who.int/health-topics/tobacco/quitting-tobacco

[67] World Health Organization. Tobacco control: Quitting. World Health Organization. Accessed May 2026. https://www.who.int/teams/health-promotion/tobacco-control/quitting

[68] World Health Organization Eastern Mediterranean Regional Office. Tobacco is addictive. World Health Organization. Accessed May 2026. https://www.emro.who.int/tfi/quit-now/tobacco-is-addictive.html

[69] LAS Journal. Nicotine products in Switzerland. LAS Journal. Published October 2024. Accessed May 2026. https://www.las-journal.com/post/nicotine-products-in-switzerland

[70] Foulkes, I. Switzerland votes to ban tobacco advertising aimed at young people. BBC News. Published February 2022. Accessed May 2026. https://www.bbc.com/news/world-europe-60333336

[71] World Health Organization Regional Office for Europe. New WHO report pushes for stronger tobacco control policies. World Health Organization Regional Office for Europe. Published July 2025. Accessed May 2026. https://www.who.int/europe/news/item/04-07-2025-new-who-report-pushes-for-stronger-tobacco-control-policies

[72] American College of Lifestyle Medicine. Clinical community integration. American College of Lifestyle Medicine. Accessed May 2026. https://lifestylemedicine.org/about-aclm/clinical-community-integration/

[73] Miller, C. Integration of lifestyle medicine into primary care: A comprehensive review. National Library of Medicine. Published 2025. Accessed May 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC12812067/

[74] Achard, M., et al. Educational level, clinical outcomes and quality of care in a Swiss cohort of patients with acute coronary syndromes. European Journal of Clinical Investigation. Published 2025. Accessed May 2026. https://www.zhh.ch/sites/default/files/zhh/2025/files/EurJClinInvestigation-2025-Achard-Educational-level-clinical-outcomes-and-quality-of-care-in-a-Swiss-cohort-of.pdf