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Non-rheumatic calcific aortic valve disease as a global driver of heart failure: Burden and three-decade trends
Lin Zhu1, Yanqing Gong2, Zijie An3
1Medical Research Center Laboratory, Pingxiang People's Hospital, Pingxiang, China.
Insights
Heart failure from non-rheumatic calcific aortic valve disease (nrCAVD) is a growing global burden in older adults. Urgent prevention and screening are needed, especially in lower-resource settings.
Area of Science:
- Cardiovascular Medicine
- Geriatrics
- Epidemiology
Background:
- Global aging and lifestyle changes increase cardiovascular disease risk.
- Non-rheumatic calcific aortic valve disease (nrCAVD) contribution to heart failure (HF) in older adults is not well understood.
Purpose of the Study:
- Quantify global trends, drivers, inequalities, and future projections of HF due to nrCAVD in individuals aged 60 and above.
- Assess the causal relationship between nrCAVD and HF.
Main Methods:
- Utilized Global Burden of Disease (GBD) 2021 data (1990-2021) for prevalence and disability metrics across 204 countries.
- Applied decomposition analysis, Social Inequality Index (SII), and Bayesian forecasting to 2040.
- Employed two-sample Mendelian randomization using FinnGen GWAS data to evaluate causality.
Main Results:
- In 2021, an estimated 1.38 million individuals aged ≥60 had HF due to nrCAVD, with a 123% increase in cases since 1990.
- Age-standardized prevalence decreased by ~16.7%, while male burden was 1.5 times higher than female.
- Population growth and aging drove increases, partially offset by epidemiological improvements; forecasts project a ~79% rise in cases by 2040.
- Mendelian randomization confirmed a causal link between nrCAVD and HF.
Conclusions:
- Heart failure due to nrCAVD is a significant and increasing global health challenge, particularly impacting aging populations in lower Socio-Demographic Index (SDI) regions.
- There is an urgent need for targeted preventive strategies, early screening, and equitable access to interventions to address this growing burden.
Background:
Global aging and lifestyle shifts raise cardiovascular disease burden, but the specific contribution of non-rheumatic calcific aortic valve disease (nrCAVD) to heart failure (HF) in older adults is incompletely defined.
Objectives:
To quantify global trends, drivers, inequalities, and future projections of HF attributable to nrCAVD among persons aged ≥60 and to assess causality.
Methods:
Using GBD 2021 estimates (1990-2021) for prevalence, Years Lived with Disability(YLDs), and age-standardized rates across 204 countries, we applied decomposition analysis, Social Inequality Index (SII), and Bayesian age-period-cohort forecasting to 2040. Two-sample Mendelian randomization (FinnGen GWAS) evaluated causality.
Results:
In 2021 an estimated 1.38 million persons aged ≥60 had HF due to nrCAVD with 123,907 YLDs-cases rose 123 % since 1990 though age-standardized prevalence fell ∼16.7 %. Male burden was ∼1.5 × female. High-SDI regions had the highest rates but burdens are rising in middle/low-SDI areas. Decomposition attributed increases to population growth (+100.9 %) and aging (+20.0 %), partially offset by epidemiological improvement (-20.9 %). Cross-country inequality declined. Forecasts project ∼79 % increases in cases and YLDs by 2040. Mendelian randomization supported a causal effect of nrCAVD on HF.
Conclusions:
These findings demonstrate that heart failure due to non-rheumatic calcific aortic valve disease represents a growing global health burden in aging populations, particularly in lower-SDI settings. Targeted preventive measures, early screening, and equitable access to effective interventions are urgently needed to mitigate this trend.
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