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Randomized Controlled Trial
. 2014 Oct 20;176(3):916-22.
doi: 10.1016/j.ijcard.2014.08.053. Epub 2014 Aug 15.

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

Ragnar Danielsen  1 , Thor Aspelund  2 , Tamara B Harris  3 , Vilmundur Gudnason  2
Affiliations
Randomized Controlled Trial

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

Ragnar Danielsen et al. Int J Cardiol. .

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.

Keywords: Aortic valve stenosis; Elderly; Epidemiology; Future prediction; Prevalence.

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Figures

Figure 1
Figure 1
The distribution of the aortic valve area (AVA) index (cm2/m2) in the echocardiography study cohort.
Figure 2
Figure 2
The relationship between categorically graded aortic valve area (AVA) index by echocardiography and the aortic valve calcium (AVC) score by computed tomography.
Figure 3
Figure 3
A ROC analysis to establish the aortic valve calcium score on computed tomography that signifies severe aortic stenosis by echocardiography (AVA index <0.6 cm2/m2) defines a score of ≥500 with a sensitivity of 70% and specificity of 95%.
Figure 4
Figure 4
The predicted number of elderly in Iceland in the coming decades according to age groups.
Figure 5
Figure 5
The number of individuals 67 years and older in the sexes combined predicted to have severe aortic stenosis based on the prevalence found by echocardiography (ECHO) and computed tomography (CT).
Figure 6
Figure 6
The relative increase in the coming decades in the number of individuals of both sexes combined with severe aortic stenosis, defined by echocardiography (ECHO) as an aortic valve area index <0.6 cm2/m2 and by computed tomography (CT) as an aortic valve calcium score ≥500. Baseline in the year 2012 is set as 1, when 1230 individuals by ECHO and 1762 by CT were estimated to have severe aortic stenosis.
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