One-fourth of older adults with no history of CVD may have asymptomatic valvular disease
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Key takeaways:
- Nearly 30% of asymptomatic people aged at least 60 years had some form of valvular heart disease.
- For individuals aged at least 75 years, the number needed to scan to diagnose one case was 15.
More than one-fourth of individuals aged 60 years or older with no history of heart disease may have asymptomatic valvular heart disease, according to a U.K. study published in the European Heart Journal – Cardiovascular Imaging.
The observed prevalence of asymptomatic valvular heart disease increased with participants’ age, so Vassilios S. Vassiliou, MBBS, PhD, FESC, FACC, clinical professor of cardiac medicine at Norwich Medical School at the University of East Anglia, and colleagues estimated a number needed to screen of 15 individuals aged 75 years or older to diagnose one case.
“We are seeing an increasing number of patients with valvular heart disease in clinics, especially in areas with older populations. Therefore, we expected that there would have been a large number of individuals with asymptomatic valvular heart disease, but perhaps we had not appreciated this could be one in three individuals over the age of 60,” Vassiliou told Healio. “This study is instrumental because for the first time we can quantify the number of echocardiography [ultrasound] scans needed to detect one case of asymptomatic valve disease. For those aged 75 and over, this number is 15. There are multiple health systems globally which are very different and funded differently, and the stakeholders for each system can now review this data and consider whether 15 scans are going to be cost-effective for their system. Certainly, in many countries this will prove to be cost-effective and should be considered.”
Screening asymptomatic volunteers for valvular disease
For the prospective study conducted from 2007 to 2016, Vassiliou and colleagues included 4,237 people older than 60 years invited from general practices in West Midlands, Aberdeenshire and Norfolk in the U.K. (mean age, 69 years; 46% men; 98% white). All participants with known CVD at baseline — thus with an indication to undergo echocardiography — were excluded from the study.
All participants underwent transthoracic echocardiography and standardized assessments of left ventricular ejection fraction, left atrial area and volume, LV wall thickness, diastolic parameters and valvular function.
Within the cohort of asymptomatic individuals with no history of CVD, valvular heart disease was detected in 28.2% of volunteers, with the most prevalent being tricuspid regurgitation in 13.8%, followed by mitral regurgitation in 12.8% and aortic valve regurgitation in 8.3%.
When evaluated for disease severity, clinically significant valvular heart disease was prevalent in 2.4% of the cohort, with 2.2% being moderately severe and 0.2% severe. Moderate mitral and aortic regurgitation were observed with a prevalence of 0.8% and 0.7%, respectively. Severe aortic stenosis and mitral regurgitation were observed with a prevalence of 0.1% and less than 0.1%, respectively.
The only risk factor significantly associated with likelihood of having at least moderate valvular heart disease was age, with an OR of 1.07 per 1-year increment (95% CI, 1.05-1.09; P < .001).
Number needed to screen to diagnose one case
The prevalence of valvular heart disease increased with age, from 21.2% for volunteers aged 60 to 64 years to 31.5% for those aged 70 to 74 years and 53.6% for those older than 85 years, according to the study.
Therefore, the researchers estimated that among patients aged 75 years or older, 15 echocardiograms are needed to diagnose one case of clinically relevant valvular heart disease.
“While the study was in a European cohort, the pathophysiology of valvular disease is not different between European, American and Asian populations, therefore we would expect the results to be fairly generalizable,” Vassiliou told Healio. “While our paper focused on asymptomatic valvular disease, it also highlights the burden of valvular disease. Therefore, people who have symptoms that could relate to valvular heart disease, notably breathless, chest pain, blackouts, dizziness or even increased fatigue, should not just put it down to ‘old age’ and should see their family physician or cardiologist to investigate whether this could relate to valvular disease, initially by listening to their hearts with a stethoscope.”
For more information:
Vassilios S. Vassiliou, MBBS, PhD, FESC, FACC, can be reached at v.vassiliou@uea.ac.uk.
Reference:
- More than a quarter of ‘healthy’ over-60s have heart valve disease, according to new research. https://www.eurekalert.org/news-releases/1048786. Published June 26, 2024. Accessed June 26, 2024.
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