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Valvular heart diseases
The modern epidemiology of heart valve disease
  1. Sean Coffey1,
  2. Benjamin J Cairns2,
  3. Bernard Iung3
  1. 1Department of Cardiology, Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
  2. 2Nuffield Department of Population Health, University of Oxford, Oxford, UK
  3. 3Cardiology Department, Bichat Hospital, and Paris 7 Diderot University, Paris, France
  1. Correspondence to Dr Bernard Iung, Cardiology Department, Bichat Hospital, AP-HP, 46 rue Henri Huchard, Paris 75018, France; bernard.iung{at}

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Learning objectives

  • To become familiar with the contemporary epidemiology of heart valve disease, including endocarditis;

  • To recognise the relationship between heart valve disease epidemiology, the ageing population and current treatment options;

  • To be aware of the probable future trends in heart valve disease epidemiology.


In this review, we will discuss the current knowledge of heart valve disease (HVD) epidemiology, how it has changed over time and possible future trends. There are large differences in HVD epidemiology between high-income and low-income countries and across different forms of HVD. The majority of morbidity and mortality attributable to HVD worldwide is due to rheumatic heart disease (RHD), which is most commonly seen in low-income countries. In high-income countries, the greatest burden of HVD referred to hospital is due to calcific aortic valve disease (CAVD). Although prevalence of HVD is low compared with coronary heart disease, the requirement for long-term follow-up, and significant investigation and treatment costs, means that the impact of HVD on healthcare systems is disproportionately large. The strong association between HVD and age, combined with the rapid ageing of populations worldwide, means that HVD has been described as the ‘next cardiac epidemic’.1

Rheumatic heart disease

Current knowledge

Acute rheumatic fever (ARF) occurs a number of weeks after Streptococcus pyogenes (group A streptococcus) infection, usually in children. ARF leads to valve inflammation through molecular mimicry between the streptococcal M protein and cardiac proteins such as myosin and vimentin, although it is likely that other mechanisms are also involved.2 The requirements for ARF to lead to chronic RHD are not yet fully established but are likely to be related to repeated episodes of often subclinical secondary infection, leading to progressive valve fibrosis and self-sustaining valve inflammation. Those with repeated infections are more likely to progress to chronic RHD, and extended antibiotic prophylaxis is recommended for those with a …

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  • Twitter Follow Sean Coffey at @drseancoffey and Benjamin Cairns at @bj_cairns

  • Contributors The manuscript outline was designed by SC and BJC. SC performed the initial literature search and wrote the first draft. BJC and BI revised the manuscript critically. All authors reviewed and approved the final version.

  • Funding SC is supported by the National Institute of Health Research (NIHR) Oxford Biomedical Research Centre Programme. BJC acknowledges support from the British Heart Foundation Centre of Research Excellence, Oxford (British Heart Foundation grant no. RE/13/1/30181).

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the Department of Health.

  • Competing interests BI has received consultant fees from Abbott, Boehringer Ingelheim, Valtech, and speaker's fees from Edwards Lifesciences.

  • Provenance and peer review Commissioned; externally peer reviewed.

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