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Senior Citizen Health & Medicine
Valve Disease will Double in the Next 20 Years Due
to Aging Population
New public health concern found in 13.3 percent of
those 75 up
 August 22, 2006 Senior citizens can add one more
health problem to the list they may well face as they get older. Research from Mayo
Clinic estimates that about 5 million adult Americans have moderate or
severe heart valve disease as a consequence of aging, according to a
study published online in The Lancet.
While rheumatic fever was previously the main cause
of valve diseases and was a major public health issue even in the middle
of the 20th century, rheumatic fever is not a serious concern in this
country today, thanks to antibiotic therapy and improved living
standards.
Valve diseases are a significant public health
concern because the proportion of our elderly population is increasing,
says Vuyisile Nkomo, M.D., cardiologist and lead author of the study.
This study shows that valve diseases increase
significantly with aging. It is a major step in understanding the scope
of the burden of valve diseases today and their contribution to
declining health with aging.
Physicians have suspected the increase in valvular
disease, but Mayos research is the first comprehensive study to look at
data from the general population and the community.
Data from the general population reveals
information on systematic samples of individuals to reveal trends; data
from the community -- in this case, Olmsted County, where Mayo Clinic is
based -- provides information on people who have already been offered
clinical attention for an illness.
Researchers used data from echocardiograms from the
general population of 11,911 participants in three National Heart, Lung
and Blood Institute-funded population studies: the Coronary Artery Risk
Development in Young Adults (CARDIA) Study, the Atherosclerosis Risk in
Communities (ARIC) Study, and the Cardiovascular Health Study (CHS).
Researchers also analyzed data from Olmsted County of adults who had
been assessed by clinically indicated echocardiograms.
In the general population studies, the prevalence
of adults diagnosed with moderate or severe valve disease increased with
age, from 0.7 percent in 18- to 44-year-olds to 13.3 percent in those 75
and older. The projected national estimate of valve diseases based on
the age and gender distribution of the 2000 U.S. population census is
2.5 percent of adults or approximately 5 million people.
In Olmsted County, 1.8 percent (adjusted to U.S.
census figures) of the adults were diagnosed with valve disease and
prevalence also increased with age, from 0.3 percent in the 18- to
44-year-olds to 11.7 percent of those 75 and older.
Remarkably, the prevalence of valve disease was
similar in the population but in the community, valve disease was
diagnosed less in women, suggesting a possible gender bias and the need
for further study, Dr. Nkomo says.
The results of this study are not trivial. We
predict -- in view of the growth and aging of the population -- that the
number of U.S. patients with valve disease will double in the next 20
years, says co-author Maurice Enriquez-Sarano, M.D., also a Mayo Clinic
cardiologist.
An echocardiogram -- a noninvasive test that uses
sound waves to create a moving picture of the heart -- is done to
evaluate murmurs or causes of shortness of breath or chest pain or heart
failure, and is ideal for detecting or confirming valve diseases, Dr.
Nkomo says.
Valve diseases are referred to as silent killers in
part because a person can have severe valve disease without having
symptoms, and it may take some time before there is heart failure.
When physicians diagnose valve disease in the
elderly, we hesitate to perform surgery because of the risks involved,
Dr. Nkomo says.
But research shows that cardiac surgery for valve
disease has now much improved results, particularly in the elderly, says
Dr. Enriquez-Sarano, pointing to Mayo Clinic research published in the
July 17 issue of Circulation.
While elderly patients undergoing valve surgery
have higher risks of operation, they benefited from the surgery as much
as younger patients, and operative risks in elderly patients over the
16-year study period declined considerably, says Dr. Enriquez-Sarano, an
author of that study.
We hope our data will generate further research to
unravel why some people get valve diseases with aging and some others do
not, he says. Also, while we are raising concerns about the
re-emergence of valve diseases, there are outstanding established
treatments and tremendous efforts to find less invasive ways to treat
valve diseases and bring about new treatments so we can prolong and
improve the quality of life of patients affected by valve diseases.
Co-authors of The Lancet paper are Christopher
Scott, Mayo Clinic; Julius Gardin, M.D., St. John Medical Center,
Detroit; Thomas Skelton, M.D., University of Mississippi Medical Center,
Jackson; and John Gottdiener, M.D., University of Maryland, Baltimore.
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