BACKGROUND: -Trends in cardiovascular mortality across Europe demonstrate significant geographical variation and an understanding of these has a central role in global public health. METHODS AND RESULTS: -Ischaemic heart disease (IHD) and cerebrovascular disease (CVD) age standardised death rates (as per International Classification of Diseases ninth/ tenth editions) were collated from the World Health Organisation mortality database, for member states of the European Union. Trends were characterised by using Joinpoint regression analysis. An overall trend for reduction in IHD mortality is observed, most pronounced in Western Europe (greater than 60% for Netherlands, United Kingdom, Ireland) for both sexes 1980-2009. Eastern-European states - Romania, Croatia and Slovakia had very modest mortality reductions. Most recently (2009), Lithuania had the highest mortality for males and females (318.1/100,000 and 166.1/100,000 respectively), followed by Latvia and Slovakia. France had the lowest mortality - 39.8/100,000 for males and 14.7/100,000 for females. Analysis of CVD mortality revealed that Austria had the largest reduction for both sexes (76.8% males, 76.5% females) 1980-2009. The smallest improvement over this period is seen in Lithuania, Poland and Cyprus (-5% to +20% approximately). France has the lowest present-day CVD mortality for both males and females (23.9/100,000 and 17.3/100,000 respectively). CONCLUSIONS: -There is growing disparity in cardiovascular mortality between Western and Eastern Europe, for which diverse explanations are discussed. The need for population-wide health promotion and primary prevention policies are emphasized.