NEW ORLEANS — Almost 12% of Americans aged 75 years or older have valvular heart disease, according to echocardiographic findings from an unselected population of 1,745 people.
The prevalence of valvular heart disease was also high (7.8%) in an unselected group of 3,879 Americans aged 65-74 years, Vuyisile T. Nkomo, M.D., reported in a poster at the annual scientific sessions of the American Heart Association.
This high prevalence of valvular heart disease in the elderly subjects, many of whom were probably asymptomatic, suggests that physicians need to assess elderly patients carefully for valvular disease by their history and physical examination, said Dr. Nkomo, a cardiologist at the Mayo Clinic in Rochester, Minn. An echocardiogram, the definitive way to identify valvular heart disease, should be obtained for people who are suspected to have clinically significant valvular disease.
“Routine screening by echocardiography of all asymptomatic elderly people may be prohibitively expensive,” he told this newspaper. “This may be where handheld echocardiography devices may be useful, if they come to be used as an extension of the physical examination.
“Waiting for symptoms to appear before making a diagnosis of valvular heart disease—or suspecting valvular disease but waiting for symptoms before getting an echocardiogram—may be waiting too long,” Dr. Nkomo added. That's because of the excess risk for people who become symptomatic, compared with those who are still asymptomatic when their valvular disease is first diagnosed.
If an asymptomatic person is found to have, for example, moderately severe mitral regurgitation, then an annual echocardiogram should be done to monitor whether the severity is progressing and intervention is needed, he said.
To examine the prevalence of valvular heart disease in the general population, Dr. Nkomo and his associates sorted through echocardiographic data collected on 11,911 people in three large, population-based studies that were sponsored by the National Heart, Lung, and Blood Institute. Data came from the Coronary Artery Risk Development in Young Adults (CARDIA) study, the Atherosclerosis Risk in Communities (ARIC) study, and the Cardiovascular Health Study (CHS). The echocardiograms were done between 1989 and 1996 in men and women who were at least 18 years old.
A total of 555 people had valvular heart disease that was of at least moderate severity, representing an overall, age- and gender-adjusted rate of 2.3%. But there was a striking link between age and the prevalence of valve disease: The rate was lowest in people under 45 years old, with a prevalence of 0.7%, and in those aged 45-54 years old, with a prevalence of 0.4%. The rate rose sharply upward among the next three age strata. The prevalence of valvular disease among people aged 55-64 years was 1.9%.
Mitral regurgitation was the most common type of valvular disease, in 6.5% of those aged 65-74 and in 9.4% of those aged 75 or older. Next most common was aortic valve regurgitation, found in 1% of people aged 65-74and 2% of those aged 75 or older. The prevalence of these and any other valvular diseases seen was roughly the same between men and women.
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