Aortic insufficiency epidemiology


 * Associate Editor-In-Chief: Varun Kumar, M.B.B.S., Lakshmi Gopalakrishnan, M.B.B.S., Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org]

Overview
The prevalence of aortic regurgitation varies with age, disease severity, gender and race. Aortic insufficiency is unusual before the age of 50 and then increased progressively.

There are increased number of diagnosed cases of aortic regurgitation due to the widespread use of echocardiography, many cases are trivial regurgitation in healthy subjects.

In a population-based cohort study by Framingham Heart; aortic regurgitation (more than or equal to trace severity on echocardiography) found to present in 13 percent of men and 8.5 percent of women.

Prevalence
There are two broad underlying causes of aortic insufficiency:


 * 1) Disease of the aortic valve itself.
 * 2) Disease of the aortic root leading to dilation and regurgitation of the aortic valve.

Aortic regurgitation secondary to dilation of the ascending aorta has overtaken valvular aortic disease as the most common cause of aortic regurgitation.

The prevalence of aortic insufficiency increases with age with higher severity in men than in women.

Developing Countries
In developing countries, rheumatic heart disease is the most common cause of aortic insufficiency and may present in second or third decade of life.

Developed Countries
In developed countries where rheumatic heart disease is rare, aortic insufficiency may be due to bi-cuspid aortic valve disease or degenerative disease which may present in the fourth to sixth decade. Endocarditis and aortic dissection are other causes. The prevalence of aortic insufficiency in the Framingham study was reported to be 4.9%, with regurgitation of moderate or greater severity occurring in 0.5%.

Race
The prevalence of aortic insufficiency does not show any variation with races in United States. However, internationally there is significant variation in the prevalence of predisposing conditions such as rheumatic heart disease.

Gender
Prevalence of aortic insufficiency is higher in men than in women. Aortic insufficiency was found in 13% of men versus 8.5% of women in Framingham study. The higher prevalence of marfan syndrome and bicuspid aortic valve in males could explain in part the greater prevalence of aortic insufficiency in men.

Age
The prevalence and severity of AR increase with age, with higher prevalence of chronic sever aortic insufficiency at 70 years. However people with congenital aortic valve/root defects such as bicuspid aortic valve and marfan syndrome develop aortic insufficiency much earlier.

Incidence
Aortic insufficiency affects approximately 5 out of every 10,000 people. It is most common in men between the ages of 30 and 60. Aortic regurgitation (more than or equal to trace severity on echocardiography) found to present in 13 percent of men and 8.5 percent of women.