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Stages of Valvular Heart Disease Among Older Adults in the Community: The Atherosclerosis Risk in Communities Study
Khaled Shelbaya1, Brian Claggett1, Pranav Dorbala1
1Brigham and Women's Hospital, Boston, MA (K.S., B.C., P.D., H.S., S.D.S., A.M.S.).
Circulation
|December 16, 2022
Summary
Subclinical valvular heart disease (VHD) is common in older adults and linked to increased cardiovascular event risk. VHD progresses significantly over six years, underscoring the need for interventions to slow its advancement.
Area of Science:
- Cardiology
- Gerontology
- Epidemiology
Background:
- Limited data exist on the prevalence, progression, and cardiovascular disease associations of American College of Cardiology/American Heart Association (ACC/AHA) valvular heart disease (VHD) stages in older adults.
- Understanding these factors is crucial for public health initiatives and clinical management in aging populations.
Purpose of the Study:
- To determine the prevalence and progression of VHD stages in a cohort of older adults.
- To assess the association between VHD stages and incident cardiovascular diseases and mortality.
- To evaluate longitudinal changes in VHD prevalence over a six-year period.
Main Methods:
- Utilized data from the Atherosclerosis Risk in Communities (ARIC) study, a prospective community-based cohort.
- Assessed VHD stages (aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation) using protocol echocardiography at two time points (2011-2013 and 2018-2019).
- Employed Cox proportional hazard models to analyze associations between VHD stages and incident cardiovascular events, adjusting for multiple covariates. Inverse probability of attrition weights were used for longitudinal analysis.
Main Results:
- Among 6118 participants (mean age 76 years), stage A VHD was present in 39%, stage B in 17%, and stage C/D in 1.1%.
- A graded association was found between VHD stages (A, B, C/D) and increased risk of all-cause mortality, heart failure, atrial fibrillation, and coronary heart disease.
- Over approximately 6.6 years, the prevalence of severe VHD (stage C/D) increased from 1% to 7%, while freedom from VHD decreased from 43% to 24%.
Conclusions:
- Subclinical and progressive valvular heart disease (VHD) are prevalent in older adults and independently associated with increased risk of cardiovascular events.
- VHD stages demonstrably progress over a six-year period in late life, with a significant rise in severe VHD.
- These findings highlight the public health importance of developing interventions to mitigate VHD progression in aging populations.
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