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Epidemiology of Valvular Heart Disease

Valvular heart Disease (VHD) is the source of significant morbidity and mortality with increasing prevalence but is poorly researched in comparison with other areas of cardiac disease. Although echocardiographic studies provide some indication of disease prevalence, accurate epidemiological data are lacking and there are no European or UK studies to date.

The largest epidemiological study of VHD examined pooled data from three population-based studies in the U.S., as well as community-based data from a separate cohort. In total, this amounted to over 28,000 adults, and documented VHD of at least moderate severity. The prevalence of VHD increased with age in both the population- and community-based cohorts, rising from 0.7% in those aged 18-44 years to 13% in those over 75 in the population-based studies, and from 0.3% to 12% in the corresponding age groups in the community-based cohort. Mitral regurgitation was the most common cause of VHD in both groups, closely followed by AS: the prevalence of MS was very low (0.2). Importantly, the authors demonstrated that the presence of VHD had a statistically significant impact on survival in both cohorts, underlining the fact that VHD is a significant health care issue.

The Euro Heart Survey on Valvular Heart Disease assessed aetiology and management of VHD in the cardiology and cardiothoracic departments of hospitals across Europe in 2001. Prospective data were collected on 5001 patients with significant primary VHD (according to specific criteria and including those undergoing intervention) or infective endocarditis, in both in- and out-patient settings. The most frequent single native left-sided valve lesion was aortic stenosis (AS), found in 43%, followed by mitral regurgitation (MR), found in 32%. Aortic regurgitation (AR) and mitral stenosis (MS) accounted for similar proportions in the remainder (13% and 12%, respectively). The dominant aetiology of AS, AR and MR was degenerative, whilst MS resulted from rheumatic disease in 85%.  Valvular regurgitation was caused by a wider range of aetiologies than stenosis, with endocarditis and congenital abnormalities featuring prominently in AR, and ischaemia an important cause of MR.
Whilst providing a useful insight into the aetiology and management of VHD in Europe in 2001, these data do not allow assessment of the prevalence of VHD.

It is hoped that the OxVALVE Study will allow an insight into the epidemiology of VHD in the United Kingdom.

Key Studies

  1. Nkomo VT, Gardin JM, Skelton TN, et al.  Burden of valvular heart diseases: a population-based study.  Lancet 2006;368:1005-1011.
  2. Singh JP, Evans JC, Levy D, et al.  Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study).  Am J Cardiol 1999;83:897-902.
  3. Lebowitz NE, Bella JN, Roman MJ, et al.  Prevalence and correlates of aortic regurgitation in American Indians: the Strong Heart study.  J Am Coll Cardiol 2000;36:461-467.
  4.  Jones EDC, Devereux RB, Roman MJ, et al.  Prevalence and correlates of mitral regurgitation in a population-based sample (the Strong Heart study).  Am J Cardiol 2001;87:298-304.
  5. Lindroos M, Kupari M, Heikkila J, Tilvis R.  Prevalence of aortic valve abnormalities in the elderly; an echocardiographic study of a random population sample.  J Am Coll Cardiol 1993;21:1220-1225.
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