The prevalence of aortic stenosis in the elderly in Iceland and predictions for the coming decades: The AGES–Reykjavík study

Abstract

Aims To evaluate the prevalence of significant aortic valve stenosis (AS) in a randomly selected study population of elderly individuals representing the general population of Iceland. Furthermore, to predict the number of individuals likely to have severe AS in the future. Methods and results Echocardiography and computed tomography (CT) data from individuals who participated in the AGES-Reykjavik study were used. Echocardiography data from 685 individuals (58% females) aged 67–95 years were available. In both sexes combined, the prevalence for severe AS, defined as an aortic valve area index of <0.6 cm2/m2, in the age groups <70, 70–79 and ≥80 years was 0.92%, 2.4% and 7.3%, respectively. A ROC analysis on the relation between the echocardiography data and the aortic valve calcium score on CT defined a score ≥500 to be indicative of severe AS. Subsequently, in a CT study cohort of 5256 individuals the prevalence of severe AS in the same age groups was 0.80%, 4.0% and 9.5%, respectively. Overall, the prevalence of severe AS by echocardiography and CT in individuals ≥70 years was 4.3% and 5.9%, respectively. A prediction on the number of elderly ≥70 years for the coming decades demonstrated that patients with severe AS will have increased 2.4 fold by the year 2040 and will more than triple by the year 2060. Conclusion This study, in a cohort of elderly individuals representative of the general population in a Nordic country, predicts that AS will be a large health problem in the coming decades.

Genome-wide analysis yields new loci associating with aortic valve stenosis

“…, Kristian Hveem 21,22 , Christopher NewtonCheh 29,30,4 , J. Gustav Smith 9 , Ragnar Danielsen 2,31 , Gudmundur Thorgeirsson 1,2,31 , Unnur Thorsteinsdottir 1,2 , Daniel F. Gudbjartsson 1,32 Aortic valve stenosis (AS) is the most common valvular heart disease, characterized by a thickened and calcified valve causing left ventricular outflow obstruction. Severe AS is a significant cause of morbidity and mortality, affecting approximately 5% of those over 70 years of age 1,2,3 .…”

“…Severe AS is a significant cause of morbidity and mortality, affecting approximately 5% of those over 70 years of age 1,2,3 . Little is known about the genetics of AS, although recently a variant at the LPA locus 4 and a rare MYH6 missense variant were found to associate with AS 5 .…”

Association between aortic valve calcification measured on non-contrast computed tomography and aortic valve stenosis in the general population

“…11 In a recent study, Danielsen et al demonstrated a significant correlation between AVC score and AVAi in a population based study of Icelandic asymptomatic males and females (288 and 397, respectively). 10 Using a threshold of 500 AU, AVC had a sensitivity (70%) and specificity (95%) to detect severe AS (AVAi < 0.6 cm 2 /m 2 ). However, Table 3 Echocardiographic data on 101 participants divided in no aortic stenosis (>0.85 cm 2 /m 2 ) and moderate/severe aortic stenosis (<0.85 cm 2 /m 2 ).…”

“…In the study by Clavel et al, the aortic valve was visualized in multiple planes, and careful measurement section by section aimed to accurately exclude contiguous calcium in coronary arteries, mitral valve annulus, or aortic wall, 4 while Danielsen el al defined AVC as calcifications within the leaflets or commissures, excluding the aortic annulus, proximal aorta and coronary arteries. 10 In our hands we were also able to exclude calcifications from the coronaries, mitral annulus and ascending aorta. However we found it very difficult to distinguish calcifications in the aortic cusps from the aortic sinus of Valsalva and the aortic annulus, primarily due to the close relationship.…”

Algengi, nýgengi, undirliggjandi sjúkdómar og langtímalifun

“…5,13,32 Sýnt hefur verið fram á að ósaeðarlokukalk ≥500 bendir til alvarlegra ósaeðarlokuþrengsla með 70% naemi og 95% sértaeki. 16 Í þessari rannsókn reyndust 26,8% hjartabilunarsjúklinga vera með ósaeðarlokukalk >500 en eingöngu 14,5% þeirra voru greindir með ósaeðarlokuþrengsli. Því er líklegt að hluti hjartabilunarsjúklinganna hafi verið með vangreind ósaeðarlokuþrengsli.…”