ArticlesBurden of valvular heart diseases: a population-based study
Introduction
In the past, valvular heart diseases were typically caused by rheumatic heart disease, which remains a major burden in developing countries.1 However, in industrialised countries, rheumatic disease has fallen substantially,1, 2 and residual valvular diseases are now mostly degenerative3, 4, 5, 6, 7, 8 and are not regarded as a major public-health problem. The low number of valve replacements, by comparison with coronary bypass surgery,9 and the low mortality attributed to valve diseases in the USA lend support to this view.10
However, several facts suggest that the role of valve disease as a public-health problem should be reconsidered. Valve diseases are poorly represented in the international classification of diseases, and their contribution to mortality and morbidity might have been ignored without echocardiography. Also, the results of the EuroHeart Survey11 suggest that a substantial burden of such disease exists, at least in Europe, a situation that is lent support by the link between degenerative valve disease, older age,3, 4, 5, 6, 7, 8 and increasing life expectancy.12
Nevertheless, the burden of valve diseases is unknown because previous studies have focused mostly on hospital patients11 and because assessment of valve diseases is clinically imprecise13 and requires large samples with echocardiography. Seminal echocardiographic studies reported some data for valve disease prevalence.6, 14, 15, 16 Although these and observational17 studies suggest a link to ageing, the absolute prevalence in specific age groups and comprehensive burden of valve diseases are unknown. Furthermore, in the community—a population that can inform us about diseases that are of potential concern—the rates of diagnosed valve diseases are unknown.
We postulated that valvular diseases are highly prevalent and are a public-health problem. Thus, our aim was to assess the prevalence, distribution patterns, and consequences of noteworthy (moderate or severe) left-sided valve disease in the general population and in the community.
Section snippets
Study population
The National Heart, Lung, and Blood Institute (NHLBI) organises the gathering of data from large epidemiological studies with well-characterised population samples. From this database, we selected studies with prospectively defined echocardiographic valvular analysis. Echocardiography with comprehensive, specific valvular analysis was done prospectively in three large national population-based epidemiological studies—the Coronary Artery Risk Development in Young Adults (CARDIA) Study,18 the
Results
There were 11 911 echocardiographs in the pooled population-based studies. The number of adult residents of Olmsted County alive in January, 2000, with available echocardiographs was 16 501, which represents 18·6% of the adult population of Olmsted County.
In the population-based studies, valvular heart disease was present in 615 (5·2%, 95% CI 4·8–5·6) participants. The national prevalence of valve diseases, taking into account the oversampling of the elderly population, and after adjustment for
Discussion
Our study has shown that the population burden of clinically noteworthy valvular heart diseases is considerable in the US population. This burden is also notable for clinically diagnosed valve disease in the community. The difference between the prevalence of such diseases in the population and the percentage of people diagnosed with valvular heart diseases in the community (2·5% vs 1·8%) is probably due to undiagnosed valve diseases.
Valve diseases detected in the general population and
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