Prevalence of valvular heart disease in the general population – Results from the population-based STAAB cohort study

Background  Valvular heart disease (VHD) is a major contributor of cardiovascular morbidity and mortality. VHD is insidious at early stage, and many patients are referred for a diagnostic test only when VHD has progressed to ≥ moderate or when the patient experiences symptoms. Valid data of VHD in the general population are scarce.

Purpose To determine population-based prevalence rates and determinants of VHD.

Methods The STAAB Cohort Study (Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression) recruited a representative sample of the population of Würzburg, Germany, stratified for age and sex, free of known heart failure. Participants underwent detailed cardiovascular phenotyping and standardized transthoracic echocardiography (TTE) including a dedicated evaluation of the mitral, tricuspid, and aortic valves. We determined mitral, tricuspid and aortic stenosis and regurgitation according to current recommendations, respectively.

Results N=4965 individuals (mean age 55 ± 12 years, 52% women) were included in the STAAB Cohort Study. Of the 4951 participants with valid echocardiogram, none had mitral or tricuspid valve stenosis. N= 3057 (61.7%) had mitral regurgitation (MR): n=2985 (98%) mild, 69 (2%) moderate, n=3 (<1%) severe. The prevalence rates of moderate or severe MR were 0.6%, 0.5%, 1.0%, 1.7%, and 4.8% in the 4th / 5th / 6th / 7th / 8^th decade of life, respectively. As for the tricuspid regurgitation (TR), n=1308 (26.4%) patients exhibited mild, n=96 (1.9%) moderate, and n=11 (0.2%) severe TR. The distribution of moderate or severe TR in the 4^th/ 5^th/ 6^th/ 7^th/ 8^th decade of life was 1.2%, 0.8%, 1.8%, 4.2% and 5.2%. With regards to aortic regurgitation (AR), n=932 (18.8%) individuals had mild AR, n=44 (0.9%) had moderate and no one had severe AR. N=55 (1.1%) patients had aortic stenosis (AS): n=40 (73%) mild, n=12 (22%) moderate, n=3 (5%) severe. Moderate or severe AS were prevalent in n=1 (0.2%) / n=4 (0.3%) / n=17 (1.3%) / n=33 (6.5%) participants in the 4^th/ 6^th/ 7^th/ 8^th decade, respectively. The overall prevalence of MR and TR in women (34% and 17.1%) was higher than in men (27.6% and 11.5%, p=0.056 and p<0.001, respectively). However, the prevalence of AR and AS showed no sex-specific differences (both p=n.s., respectively).

Conclusions In this well-characterized population-based sample, stratified for age and sex, MR was the most common VHD, followed by TR, AR and AS. In most participants, VHD was mild. The prevalence rates of moderate or severe VHD increased from the 6^th decade and reached the highest in the 8^th decade. A sex-specific distribution of moderate or severe VHD with higher prevalence of TR and MR was apparent in women. The identification of potentially sex-specific risk factors of VHD remains subject to further research.