Subclinical Valvular Heart Disease Increasingly Common Among Older Adults

The prevalence of subclinical valvular heart disease is common among older adults, with 39% having stage A and 17% having stage B valvular heart disease.

Subclinical valvular heart disease (VHD) is increasingly prevalent among older adults, with the progression of VHD occurring with advancing age, according to study findings published in the journal Circulation.

Researchers from Brigham and Women’s Hospital in the United States sourced data for this analysis from the Atherosclerosis Risk in Communities (ARIC) study, which was a prospective epidemiological cohort study that recruited participants between 1987 and 1989. The subset of patients (n=6118), who attended visits 5 in 2011-2013 and 7 in 2018-2019 and underwent echocardiography, were staged for aortic and mitral stenosis and regurgitation according to the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. Prospective trends in VHD were evaluated between visits 5 and 7.

The study participants were mean age, 76 at visit 5; 42% were men; 22% were Black; 62% were ever smokers; and 83% had hypertension.

At visit 5, 2640 had no VHD, 2362 had Stage A VHD, 1010 Stage B VHD, and 66 Stage C/D VHD. In general, age and the prevalence of comorbidities were positively related with advanced VHD stage.

These findings clarify the burden of VHD in late life and highlight the public health importance of interventions to mitigate VHD progression.

Stratified by valve and disease type, Stages A, B, C, and D aortic stenosis was observed among 15.4%, 4.1%, 0.4%, and 0.4% of participants, respectively. A total of 32 participants had undergone aortic valve replacement. Stage A mitral regurgitation was observed among 38.6% of participants.

At visit 7, 15% of patients presented with no VHD, 20% with Stage A VHD, 10% with Stage B VHD, 4% with Stage C/D VHD, and 1% with a replaced valve. The remaining participants were lost to follow-up (30%) or died (20%).

In general, comparing visits 5 and 7 indicated the rates of no VHD (43.2% vs 23.8%) and Stage A VHD (38.6% vs 31%) decreased, whereas Stage C/D VHD (1.1% vs 7.3%) and valve replacement (1.1% vs 2.2%) increased over time, respectively.

During a median follow-up of 5.5-6.5 years, the following occurred:

  • new-onset atrial fibrillation (AF) occurred among 564 patients;
  • new-onset heart failure (HF) among 553 patients;
  • new-onset coronary heart disease (CHD) among 300 patients;
  • incident stroke among 250 patients; and
  • mortality among 1295 patients.

In general, risk for all outcomes except stroke increased with VHD stage, in which compared with no VHD, among patients with VHD, risk was increased for:

  • mortality (adjusted hazard ratio [aHR] range, 1.2-2.3);
  • HF (aHR range, 1.9-4.7);
  • AF (aHR range, 1.4-2.4), CHD (aHR range, 1.4-2.9); and
  • the composite outcome of events (aHR range, 1.2-2.2).

Findings were similar in a sensitivity analysis including only participants who attended both visits.

A limitation of this study was the loss of study participants to follow-up or death, which may have introduced healthy selection bias.

These data indicated that subclinical VHD was common among the general population as was progression to more severe disease with age. “These findings clarify the burden of VHD in late life and highlight the public health importance of interventions to mitigate VHD progression,” the researchers concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Shelbaya K, Claggett B, Dorbala P, et al. Stages of valvular heart disease among older adults in the community: The Atherosclerosis Risk in Communities Study. Circulation. Published online December 16, 2022. doi:10.1161/CIRCULATIONAHA.122.061396