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Original research article
Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study
  1. Pontus Andell1,
  2. Xinjun Li2,
  3. Andreas Martinsson1,
  4. Charlotte Andersson3,
  5. Martin Stagmo1,
  6. Bengt Zöller2,
  7. Kristina Sundquist2,
  8. J Gustav Smith1,4
  1. 1 Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
  2. 2 Center for Primary Health Care Research, Lund University, Malmö, Sweden
  3. 3 Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
  4. 4 Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
  1. Correspondence to Dr Pontus Andell, Department of Cardiology, Lund University, SE-221 85, Lund, Sweden; pontus.andell{at}


Objective Transitions in the spectrum of valvular heart diseases (VHDs) in developed countries over the 20th century have been reported from clinical case series, but large, contemporary population-based studies are lacking.

Methods We used nationwide registers to identify all patients with a first diagnosis of VHD at Swedish hospitals between 2003 and 2010. Age-stratified and sex-stratified incidence of each VHD and adjusted comorbidity profiles were assessed.

Results In the Swedish population (n=10 164 211), the incidence of VHD was 63.9 per 100 000 person-years, with aortic stenosis (AS; 47.2%), mitral regurgitation (MR; 24.2%) and aortic regurgitation (AR; 18.0%) contributing most of the VHD diagnoses. The majority of VHDs were diagnosed in the elderly (68.9% in subjects aged ≥65 years), but pulmonary valve disease incidence peaked in newborns. Incidences of AR, AS and MR were higher in men who were also more frequently diagnosed at an earlier age. Mitral stenosis (MS) incidence was higher in women. Rheumatic fever was rare. Half of AS cases had concomitant atherosclerotic vascular disease (48.4%), whereas concomitant heart failure and atrial fibrillation were common in mitral valve disease and tricuspid regurgitation. Other common comorbidities were thoracic aortic aneurysms in AR (10.3%), autoimmune disorders in MS (24.5%) and abdominal hernias or prolapse in MR (10.7%) and TR (10.3%).

Conclusions Clinically diagnosed VHD was primarily a disease of the elderly. Rheumatic fever was rare in Sweden, but specific VHDs showed a range of different comorbidity profiles . Pronounced sex-specific patterns were observed for AR and MS, for which the mechanisms remain incompletely understood.

  • valvular heart disease
  • epidemiology
  • aortic stenosis
  • aortic regurgitation
  • mitral regurgitation

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  • Contributors All authors made substantial contributions to the conception and design of the work. PA

    drafted the work and all authors revised it critically for important intellectual content. All authors have given final approval of the version to be published.

    All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. KS and JGS jointly supervised this work.

  • Funding The European Research Council, Swedish Heart-Lung Foundation, the Wallenberg Center for Molecular Medicine in Lund, the Crafoord Foundation, the Swedish National Health Service, Skåne University Hospital in Lund (PA, JGS and AM) and the Swedish Research Council (XL, AM, JGS and KS).

  • Competing interests None declared.

  • Patient consent Register study, not applicable.

  • Ethics approval Regional Ethics committee at Lund University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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