Temporal trends in incidence, prevalence, and death of aortic stenosis in Korea: a nationwide population‐based study

Abstract

Aims We aim to determine the temporal trends of incidence, prevalence, and death of aortic stenosis (AS, I35.0) in an East Asian population. Methods and results Data for 3773 patients who were newly diagnosed with AS from 2006 through 2017 were extracted from the National Health Insurance Service in Korea. The age‐standardized incidence rate, prevalence rate, and death rate, survival rate (SR), and death risk of AS were calculated. Overall, the mean (standard deviation) age of AS patients was 69.9 (15.3) years [66.2 (15.7) years for men and 72.7 (14.4) years for women (P = 0.007)], and the proportion of men was 42.7%. The proportion of AS patients ≥60 years old was 80% (71.8% in men and 86% in women, P < 0.001). The proportion of patients who died of AS was 36.4% during the period from 2006 through 2017. The most common causes of death were disease of the circulatory system. The age‐standardized incidence, prevalence, and death rates in 2017 were 0.85, 2.79, and 0.58 persons per 100 000 persons, respectively. The 10 year SR was 49.2%. The higher adjusted HRs [95% CI] for AS were observed in 70‐ to 79‐year‐old people (9.08 [1.27, 64.7], P = 0.027), in individuals 80 years of age or older (22.7 [3.18, 161.9], P = 0.001), in men (1.46 [1.31, 1.63], P < 0.001), among the middle socioeconomic group (1.19 [1.03, 1.37], P = 0.016), among the lower income levels (1.32 [1.17, 1.49], P < 0.001), in those with myocardial infarction (1.57 [1.16, 2.13], P = 0.003), with heart failure (1.63 [1.44, 1.85], P < 0.001), with ischaemic stroke (3.26 [1.20, 8.85], P = 0.015), with haemorrhagic stroke (2.51 [1.94, 3.25], P = 0.02), with chronic kidney disease (2.51 [1.94, 3.25], P < 0.001), and with malignant neoplasm (2.33 [1.64, 3.31], P < 0.001). Conclusions The proportion of AS at age ≥60 years was 80%. For AS, the age‐standardized incidence rates were steady, prevalence rates increased, and death rates decreased by year over a decade. The 10 year SR of AS was about 50%. The most common cause of death in AS was disease of the circulatory system. Given the progressively higher incidence of AS with age continued efforts are required to increase awareness regarding AS‐related symptoms and potential complications in aged people.

Impact of Sex on Mortality in Patients Undergoing Surgical Aortic Valve Replacement

“…Many studies have attempted to identify the possible effects of sex on postoperative outcomes from severe AS, but the issue remains controversial. Numerous reports have shown that female sex is associated with a poor prognosis following SAVR for severe AS [ 3 , 11 , 12 , 21 , 22 , 23 ]. However, most of those studies focused on patients who had undergone combined SAVR and coronary artery bypass graft surgeries [ 3 , 21 , 22 ] and found poorer short-term mortality outcomes in females.…”

“…Numerous reports have shown that female sex is associated with a poor prognosis following SAVR for severe AS [ 3 , 11 , 12 , 21 , 22 , 23 ]. However, most of those studies focused on patients who had undergone combined SAVR and coronary artery bypass graft surgeries [ 3 , 21 , 22 ] and found poorer short-term mortality outcomes in females. Previous studies have shown that females have a poorer long-term mortality outcome following coronary artery bypass graft surgery [ 24 ].…”

“…Aortic stenosis (AS) is currently the second most common valvular heart disease in the United States, where it affects about 12.4% of those aged over 75 years and has an increasing incidence with advancing age [ 1 , 2 ]. In a recent study, the proportion of people with AS was 80% in the population over 60 years of age in South Korea [ 3 ]. The pathological mechanism of AS is based on chronic pressure overload in the left ventricle (LV), which leads to changes in its geometry and molecular composition, including myocardial hypertrophy, ventricular dilation, and fibrosis [ 4 ].…”

Perioperative risk of non-cardiac surgery in patients with asymptomatic significant aortic stenosis: a 10-year retrospective study

“…Within this population, aortic valve stenosis (AS) is a representative geriatric disease, and the demand for surgical interventions in patients with significant AS is anticipated to escalate. 1,2 In patients with AS, increased afterload results in concentric hypertrophy, which leads to diastolic dysfunction and decreased coronary flow reserve. 3 In addition, patients with AS have many underlying diseases, such as coronary artery disease (CAD), hypertension, and diabetes.…”

Assessment Regarding the Safety of Stress Cardiovascular Magnetic Resonance in Patients With Moderate to Severe Aortic Stenosis

“…The age-standardized incidence, prevalence, and death rate of AS were approximately 1 person, 3 persons, and 0.2 persons per 100,000 in 2017, respectively. 1) …”