Valvular heart disease: the next cardiac epidemic

The epidemiology of valvular heart disease (VHD) has changed dramatically over the past 50 years in developed nations. While rheumatic disease is now uncommon, a steady rise in life expectancy has been accompanied by a progressively increasing frequency of degenerative valve disease. Although an accurate overall picture of the epidemiology of VHD has yet to be established, the overall prevalence in the USA is 2.5% with wide age-related variation from 0.7% in those aged 18–44 years to 13.3% in those over the age of 75.1 Similar age dependency has been shown in hospital-based surveys in Europe.2 3 Population statistics worldwide project an imminent increase in the elderly population—in the UK, for example, there will be an estimated 4 million people aged between 75 and 84 in the UK by 2018, and the population beyond the age of 85 is set to double by 2028. VHD is associated with significant morbidity and mortality,2 and treatment, particularly by valve surgery, is expensive. Furthermore, research concerning the epidemiology, pathophysiology and clinical management of VHD is limited. Mechanisms underlying aortic stenosis are poorly elucidated and those involved in mitral regurgitation are virtually unknown. Accurate data concerning the contemporary prevalence and natural history of VHD are required to inform economists and policy makers responsible for healthcare planning and the allocation of resources to newer developments, such as percutaneous valve implantation and repair. The recent National Adult Cardiac Surgery Database report for Great Britain and Ireland provides important detail not available in more general surveys—including a significant increase in all types of valve surgery and variation in the type of surgery over time and between hospitals—and highlights limitations and geographical variation in the current provision of healthcare for VHD.4 VHD may be detected as an incidental finding in the asymptomatic patient or manifest at …