非リウマチ性石灰化大動脈弁疾患（nrCAVD）が心不全の世界的な要因となること：負担と30年間の傾向

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.

To quantify global trends, drivers, inequalities, and future projections of HF attributable to nrCAVD among persons aged ≥60 and to assess causality.

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.

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.

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.