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Global epidemiology of valvular heart disease

Nature Reviews Cardiology volume 18, pages 853–864 (2021)Cite this article

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Abstract

Valvular heart disease (VHD) is a major contributor to loss of physical function, quality of life and longevity. The epidemiology of VHD varies substantially around the world, with a predominance of functional and degenerative disease in high-income countries, and a predominance of rheumatic heart disease in low-income and middle-income countries. Reflecting this distribution, rheumatic heart disease remains by far the most common manifestation of VHD worldwide and affects approximately 41 million people. By contrast, the prevalence of calcific aortic stenosis and degenerative mitral valve disease is 9 and 24 million people, respectively. Despite a reduction in global mortality related to rheumatic heart disease since 1900, the death rate has remained fairly static since 2000. Meanwhile, deaths from calcific aortic stenosis have continued to rise in the past 20 years. Epidemiological data on other important acquired and congenital forms of VHD are limited. An ageing population and advances in therapies make an examination of the changing global epidemiology of VHD crucial for advances in clinical practice and formulation of health policy. In this Review, we discuss the global burden of VHD, geographical variation in the presentation and clinical management, and temporal trends in disease burden.

Key points

  • The prevalence of valvular heart disease (VHD) is growing worldwide as a consequence of improved survival and the ageing population.

  • Rheumatic heart disease (RHD) remains the most prevalent form of VHD and contributes to substantial premature mortality and reduced quality of life; RHD is primarily encountered in middle-income and low-income countries and specific (usually indigenous) groups in high-income countries.

  • Calcific aortic valve disease is highly age-related, and its prevalence is increasing rapidly in high-income countries.

  • Endocarditis is increasing in incidence and prevalence as a consequence of improved diagnosis and an ageing, susceptible population undergoing an increasing range and complexity of medical interventions.

  • Valve abnormalities are a frequent component of congenital heart disease; bicuspid aortic valve is most commonly encountered, and its prevalence seems to be uniform across the world.

  • Epidemiological information on patients who have undergone surgical or transcatheter valve intervention is limited, but this population is growing exponentially (especially in high-income countries); forecasting trends is difficult owing to the rapid evolution of these interventions and of therapies that might reduce the need for interventional treatment.

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Fig. 1: Age-specific and sex-specific prevalence of three forms of valvular heart disease.
Fig. 2: Global prevalence of three forms of valvular heart disease.
Fig. 3: Changes in the absolute numbers of deaths and prevalence of three forms of valvular heart disease from 1990 to 2019.
Fig. 4: Changes in age-standardized death rates due to three forms of valvular heart disease from 1990 to 2019.
Fig. 5: Changes in age-standardized prevalence of three forms of valvular heart disease from 1990 to 2019.
Fig. 6: Global variation in the uptake of TAVI.

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Author notes

  1. These authors contributed equally: Sean Coffey, Ross Roberts-Thomson.

Authors and Affiliations

  1. Department of Medicine – HeartOtago, University of Otago, Dunedin, New Zealand

    Sean Coffey

  2. Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia

    Ross Roberts-Thomson

  3. Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia

    Ross Roberts-Thomson & Alex Brown

  4. University of Adelaide, Adelaide, SA, Australia

    Ross Roberts-Thomson & Alex Brown

  5. Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia and Perth Children’s Hospital, Perth, WA, Australia

    Jonathan Carapetis

  6. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China

    Mao Chen

  7. Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

    Maurice Enriquez-Sarano

  8. Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children’s Hospital, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa

    Liesl Zühlke

  9. Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa

    Liesl Zühlke

  10. Department of Cardiology, St Thomas’ Hospital, London, UK

    Bernard D. Prendergast

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S.C. and R.R.-T. researched data for the article. S.C., R.R.-T. and B.D.P. wrote the manuscript. All the authors contributed to discussions about content, and revised and edited the manuscript before submission.

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Coffey, S., Roberts-Thomson, R., Brown, A. et al. Global epidemiology of valvular heart disease. Nat Rev Cardiol 18, 853–864 (2021). https://doi.org/10.1038/s41569-021-00570-z

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