The league table, compiled by the European Society of Cardiology (ESC), puts Finland in second place and Britain in third.
Each year, heart disease claims the lives of more than four million Europeans, accounting for around 40% of all deaths in the under-74s and for nine million hospital admissions.
Latest figures show that the death rate from heart disease is decreasing fastest in the Scandinavian countries.
In Russia the death rate from heart disease for men and women aged 35-74 is eight times that in France, while the death rate in Ireland is twice that of Italy.
Death rates from cardiovascular disease are lowest in Mediterranean countries, such as France, Israel and Spain and highest in Eastern European countries such as Romania and Russia and the Ukraine, where the rate recently increased by as much as 60%.
Changes in lifestyle and appropriate use of medicines have started to decrease heart disease in Ireland but the decrease is happening at a faster rate in other European countries, according to the Irish Heart Foundation (IHF).
IHF chief executive Michael O'Shea said Ireland was already top of the league for deaths from coronary heart disease in the EU.
"We are improving but we are not improving as fast as other European countries," he said.
Cardiovascular disease, which accounted for over 50% of all deaths in Ireland in the mid-1970s, now accounts for 41% of deaths 12,660 men and women.
While the Government has already implemented much of the National Cardiovascular Strategy, there was still a lot more to be done to make a real impact on the situation, said Mr O'Shea.
The strategy, initiated in 1999, made 211 recommendations across the entire spectrum of heart disease and the IHF wants to see the Government to act a little faster in implementing it.
Ireland has seven consultant cardiologists per million people, compared to the EU average of 35 per million.
The State is addressing the situation with the appointment of 17 consultant cardiologists.
"While the appointment of the consultants will not bring Ireland anywhere near it should be, at least it is a major step in the right direction," he said.