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Worldwide perspective of valve disease
  1. Jordi Soler-Soler,
  2. Enrique Galve
  1. Servicio de Cardiología, Hospital General Universitari Vall d'Hebron. Barcelona, Spain
  1. Professor Jordi Soler-Soler, Servicio de Cardiología, Hospital General Universitari Vall d'Hebron, P Vall d'Hebron, 119-129, 08035 Barcelona, Spain email: jsoler{at}

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Valvar heart disease is a paradigm of the changing aetiology of human disease. In particular, we have witnessed dramatic changes in the incidence of rheumatic heart disease (fig 1); such changes have been limited mostly to industrialised countries, highlighting the role of factors other than microorganisms in this disease. Interestingly, the frequency of valvar heart disease is still high in industrialised countries, as new types of valve disease become increasingly prevalent (fig 2). The most important of them is degenerative valve disease, which relates directly to the increased lifespan of people living in industrialised countries compared to those in developing countries. On the other hand, aetiologies related to the relative wealth of industrialised countries have also appeared, the most dramatic example being valve disease related to appetite suppressant drugs.

Figure 1

Changes in the incidence of rheumatic fever. Rheumatic fever increased during the period of the industrial revolution, possibly because of overcrowding in urban areas. Later on, it reached a steady state as living standards began to improve. Finally, in the postindustrial period, the decline in incidence was associated with an easier access to medical care, widespread use of antibiotics, and reduced overcrowding. At the present time, when the disease is considered to be nearly eradicated, isolated outbreaks continue to occur.

Figure 2

Evolution of different types of valve disease in the developed world. Rheumatic valve disease has witnessed an abrupt decline, which has been matched in part by an increase in degenerative valve disease, related to aging. Meanwhile, new types of valve disease have emerged, although they account for a minority of all cases in comparison with the old incidence of rheumatic valve disease or the current incidence of degenerative valve disease.

Rheumatic valve disease

Although rheumatic fever was thought to be nearly eradicated from developed countries, it continues to be a challenge because of its …

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