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The burden of aortic stenosis (AS) has been the subject of particular attention over the last decades due to growing evidence that, beyond its present impact in the elderly, AS is also likely to increase in the near future, with at least a predicted doubling of cases in the next 50 years.1
The analysis of the cumulative burden of AS performed by Owen et al 2 in the large cohort of elderly patients of the Cardiovascular Health Study (CHS) is therefore of particular interest. Previous analyses of the CHS cohort have led to major advances in the knowledge of the determinants and prognosis of calcific aortic disease, and the CHS presents unique features for the purpose of analysing the very long-term burden of AS. The CHS cohort was indeed prospectively designed for an accurate echocardiographic assessment of the aortic valve function, which was not current practice in a large patient sample in the late 1980s and early 1990s. The criteria used for the baseline evaluation of AS severity correspond to the contemporary criteria for high-gradient AS, which is the most frequent presentation of AS and for which there has always been strong indication for intervention in all guidelines. Finally, the CHS cohort was a population-based cohort of more than 5000 patients aged 65 or older, thereby avoiding selection bias inherent in hospital-based cohorts.
The main finding of the paper by Owen et al 2 is that the 20-year cumulative frequency of 3.7% for probable or definite clinically significant AS is somewhat higher than previously reported prevalence ranges from studies, which also included less severe AS presentations. When adding cases classified as possible AS, the 20-year cumulative frequency of AS increased to 4.7%. It is likely that the dynamic overview of the cumulative occurrence of …
Contributors BI and DA both drafted this editorial.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests BI: speaker’s fee from Edwards Lifesciences.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.