Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study

• Published in: Heart (British Cardiac Society) Vol. 103; no. 21; pp. 1696 - 1703
• Main Authors: Andell, Pontus, Li, Xinjun, Martinsson, Andreas, Andersson, Charlotte, Stagmo, Martin, Zöller, Bengt, Sundquist, Kristina, Smith, J Gustav
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2017; Heart
• Series: Original research article
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Aortic regurgitation; Aortic stenosis; Cardiac and Cardiovascular Systems; Cardiovascular disease; Child; Child, Preschool; Clinical Medicine; Comorbidity; Congenital diseases; Epidemiology; Female; Health risk assessment; Heart Valve Diseases - diagnosis; Heart Valve Diseases - epidemiology; Hospitals; Humans; Incidence; Infant; Infant, Newborn; Kardiologi; Klinisk medicin; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Mitral regurgitation; Prevalence; Registries; Risk Factors; Sex Distribution; Sweden - epidemiology; Time Factors; Valvular Heart Disease; Young Adult; United States > US; Sweden; epidemiology; valvular heart disease; aortic regurgitation; aortic stenosis; mitral regurgitation
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2016-310894

ObjectiveTransitions in the spectrum of valvular heart diseases (VHDs) in developed countries over the 20th century have been reported from clinical case series, but large, contemporary population-based studies are lacking.MethodsWe used nationwide registers to identify all patients with a first diagnosis of VHD at Swedish hospitals between 2003 and 2010. Age-stratified and sex-stratified incidence of each VHD and adjusted comorbidity profiles were assessed.ResultsIn the Swedish population (n=10 164 211), the incidence of VHD was 63.9 per 100 000 person-years, with aortic stenosis (AS; 47.2%), mitral regurgitation (MR; 24.2%) and aortic regurgitation (AR; 18.0%) contributing most of the VHD diagnoses. The majority of VHDs were diagnosed in the elderly (68.9% in subjects aged ≥65 years), but pulmonary valve disease incidence peaked in newborns. Incidences of AR, AS and MR were higher in men who were also more frequently diagnosed at an earlier age. Mitral stenosis (MS) incidence was higher in women. Rheumatic fever was rare. Half of AS cases had concomitant atherosclerotic vascular disease (48.4%), whereas concomitant heart failure and atrial fibrillation were common in mitral valve disease and tricuspid regurgitation. Other common comorbidities were thoracic aortic aneurysms in AR (10.3%), autoimmune disorders in MS (24.5%) and abdominal hernias or prolapse in MR (10.7%) and TR (10.3%).ConclusionsClinically diagnosed VHD was primarily a disease of the elderly. Rheumatic fever was rare in Sweden, but specific VHDs showed a range of different comorbidity profiles . Pronounced sex-specific patterns were observed for AR and MS, for which the mechanisms remain incompletely understood.