Unidentified valvular heart disease very common in elderly

By Eleanor McDermid

Over half of community-living elderly people are likely to have valvular heart disease (VHD), show findings of OxVALVE-PCS.

The study, which appears in the European Heart Journal, also identifies atrial fibrillation (AF) and socioeconomic status as important predictors of VHD.

Bernard Prendergast (Oxford University Hospitals NHS Foundation Trust, UK) and co-workers detected VHD in 50.8% of the first 2500 people enrolled in the study - and this was after excluding people with a pre-existing VHD diagnosis.

Most people had mild VHD; however, the overall prevalence of clinically significant VHD amounted to 11.3% when accounting for people with a pre-existing diagnosis.

And given the high prevalence of previously unidentified VHD, the researchers "infer that the number of individuals with clinically significant VHD will increase substantially over the next five decades".

The 2500 participants were aged an average of 73 years and 51.5% were female. The prevalence of VHD (including excluded patients with previous diagnoses) rose with older age, from around 45% in people aged 65-69 years to nearly 80% in those aged 85 years or older. The corresponding rates of moderate or severe VHD rose from around 5% to 30%.

Among patients with newly detected VHD, the most common finding was aortic sclerosis, in 34%, followed by mitral regurgitation in 22.1% and aortic regurgitation in 15.2%. The "most prognostically significant" finding, of aortic stenosis, occurred in 1.3% of patients. More than a third of affected patients had multiple valve abnormalities.

Of note, the likelihood of having VHD was highest among people with low socioeconomic status, with those in the two most deprived of five socioeconomic categories around twice as likely to have VHD as those in the most affluent category.

"The novel finding of increased VHD in more deprived socioeconomic groups (even in a high-income country such as the UK) places VHD among the group of diseases that disproportionately affects the poor", write Prendergast et al.

Another important predictor - of both any and clinically significant VHD - was AF, which nearly doubled the risk of any VHD and more than tripled the risk of significant VHD.

"Our data indicate that AF is an important and easily identifiable marker of silent VHD in asymptomatic individuals in primary care and that auscultation and routine echocardiography are appropriate", concludes the team.

Source: Eur Heart J 2016; Advance online publication

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