Mapping cardiovascular inequality: how the ASCVD Heatmap turns real-world data into targeted prevention
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Atherosclerotic cardiovascular disease (ASCVD) is largely preventable — and yet, up to 750,000 Belgians live with it, and it was responsible for 21.3% of all deaths in the country in 2019. The economic burden runs to around €5 billion a year, or roughly €6,933 per patient. Behind those headline numbers sits a less-discussed truth: cardiovascular risk is not evenly distributed. It clusters in neighborhoods, and it tracks closely with where people live, work, and how they engage with the healthcare system. That is the gap the ASCVD Heatmap was built to close.
A multistakeholder project, now backed by peer-reviewed science
The ASCVD Heatmap is a collaboration between KU Leuven, Onafhankelijke Ziekenfondsen (MLOZ), Cascador, EPCON, and Novartis. It brings together administrative health insurance claims, clinical primary care data, and a multidimensional vulnerability index — all calibrated down to the level of Belgian statistical sectors (essentially, neighborhoods).
The underlying methodology and findings have now been published, open access, in BMC Public Health. You can read the full paper here https://link.springer.com/article/10.1186/s12889-026-27365-6
For the policy implications and recommendations, see the accompanying ASCVD Heatmap Policy Paper — "Unlocking real-world data: the ASCVD Heatmap as foundation for more equitable and effective cardiovascular health strategies."
What the data show
By overlaying ASCVD prevalence with a refined socioeconomic vulnerability index (built on the Belgian Index of Multiple Deprivation, covering income, employment, education, housing, health and crime) and a healthcare use index (GP, dentist, cardiologist, gynecologist visits), three clear patterns emerge.
1. ASCVD prevalence is 57% higher in the most vulnerable municipalities than in the least vulnerable ones. The peer-reviewed analysis confirms this with a median prevalence 1.57 times higher (95% CI: 1.46–1.65) in high-vulnerability areas.
2. People in the most vulnerable areas use 32% less primary care and around 40% more secondary (specialist) care than people in the least vulnerable municipalities. They are entering the system later, and through more expensive doors.
3. The geography is striking. High-vulnerability and high-ASCVD-burden areas overlap visibly along the Belgian coast and across the Mons–Charleroi–Liège–Dinant axis in Wallonia.
Dr. Nicholas Cauwenberghs (KU Leuven) notes:
"Socioeconomic vulnerability and delayed care often go hand in hand. Cardiovascular disease is not just a clinical challenge, it's a societal one as well."
From insight to action
The Heatmap is not just an academic exercise. It is built to be used.
For healthcare professionals, it identifies high-risk, under-screened areas where targeted outreach and earlier intervention will have the biggest impact — empowering primary care zones and community initiatives like the Gezondheidsmakers in Flanders to design interventions where they are most needed.
For policymakers, it provides an objective basis for deploying prevention and screening campaigns at municipal and neighborhood level, and for shaping the upcoming national cardiovascular health action plan in a way that is proportional to local need. It enables asymmetrical health policies — tailoring approaches to regional realities rather than applying a uniform template.
For mutualities and local actors, it offers a shared factual basis to align interventions and plan together, and over time, to measure whether those interventions actually move the needle.
As Dr. Ann Ceuppens (Onafhankelijke Ziekenfondsen) put it:
"Bringing together data from different sources has significant added value for proactive health policy. This project shows how combining administrative and clinical data can be used for targeted prevention strategies."
Two recommendations going forward
Building on the peer-reviewed evidence and the policy paper, two priorities stand out:
Use the ASCVD Heatmap to drive targeted interventions. Healthcare professionals and regional health actors can use it today to identify high-risk, high-need areas and concentrate prevention resources where they will yield the largest reduction in preventable disease.
Embed the methodology into policy frameworks beyond ASCVD. The integrated data approach demonstrated here — combining claims, clinical, and socioeconomic data at small-area level — is a template for population health management generally. Institutionalising it would lock in sustained focus on early intervention, regional equity, and measurable outcomes.
Try it yourself
The ASCVD Heatmap is publicly accessible through EPCON's Epi-control platform:
First-time users can register with their email address, confirm via the verification link, and then explore the interactive layers — vulnerability, primary and secondary care use, and ASCVD intervention ratios — at municipal and statistical-sector level.
Acknowledgements
The ASCVD Heatmap was developed with the input of an Alignment Board including researchers and clinicians from KU Leuven, UZ Leuven, ZOL, Helora, CHU Brussels, Onafhankelijke Ziekenfondsen, Cascador and EPCON. The work was funded by Novartis Pharma Belgium; analyses, interpretation, and publication were carried out independently by the research team.
