Aortic regurgitation epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Mohammed A. Sbeih, M.D. [2]; Usama Talib, BSc, MD [3]

Overview

The prevalence of aortic regurgitation varies with age, geographic location, and gender.[1] aortic regurgitation is unusual before the age of 50 and then increases progressively later in life. Worldwide the most common cause of aortic regurgitation is the rheumatic heart disease, particularly in the Asia, the Middle East, and the North Africa. In the United States, senile degenerative calcific aortic valve disease and bicuspid aortic valve disease are the most common causes.[2]

Epidemiology and Demographics

Prevalence

The Framingham Heart Study, a prospective epidemiological study, evaluated the prevalence and severity of aortic regurgitation and other valvular diseases by color Doppler examinations in 1,696 men and 1,893 women. The study revealed that the prevalence of aortic regurgitation (ranging in severity from trace to ≥ moderate regurgitation) is 13.0% in men and 8.5% in women.[1]

Age

The prevalence of aortic regurgitation increases with age.[1][3][4] It is infrequent in young patients, and occurs in < 1% of subjects under the age of 70. However people with congenital aortic valve/root defects such as bicuspid aortic valve disease and Marfan syndrome may develop aortic regurgitation much earlier in life.[5][6]

Shown below are tables depicting the prevalence of AR by age and severity in men and women according the results of the Framingham Heart Study.[1]

Severity of AR Prevalence of AR by age in men
26-29 40-49 50-59 60-69 70-83
No AR (%) 96.7 95.4 91.1 74.3 75.6
Trace (%) 3.3 2.9 4.7 13 10
Mild (%) 0 1.4 3.7 12.1 12.2
Moderate or severe (%) 0 0.3 0.5 0.6 2.2
Severity of AR Prevalence of AR by age in women
26-29 40-49 50-59 60-69 70-83
No AR (%) 98.9 96.6 92.4 86.9 73
Trace (%) 1.1 2.7 5.5 6.3 10.1
Mild (%) 0 0.7 1.9 6 14.6
Moderate or severe (%) 0 0 0.2 0.8 2.3

Gender

aortic regurgitation is more common in men than in women.[1][3][4] In the Framingham heart population cohort study, aortic regurgitation (more than or equal to trace severity on echocardiography) was observed in 13 percent of men and 8.5 percent of women.[1] The higher prevalence of marfan syndrome and bicuspid aortic valve in males could explain in part the greater prevalence of aortic regurgitation in men.[5][6]

Race

The prevalence of aortic regurgitation does not show any variation by race in United States. However, internationally there is significant variation in the prevalence of predisposing conditions such as rheumatic heart disease which is more common in the Asia, the Middle East, and the North Africa.[7]

Developed Countries

In developed countries where rheumatic heart disease is rare, aortic regurgitation may be due to bicuspid aortic valve disease or senile degenerative calcific aortic valve disease which may present in the fourth to sixth decade. Endocarditis and aortic dissection are other causes. The prevalence of any aortic regurgitation in the Framingham study was reported to be 4.9%, with regurgitation of moderate or greater severity occurring in 0.5%.[1]

Developing Countries

In developing countries, rheumatic heart disease is the most common cause of aortic regurgitation and may present in second or third decade of life.[8]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ (1999). "Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study)". The American Journal of Cardiology. 83 (6): 897–902. PMID 10190406. Retrieved 2011-12-27. 
  2. Nishimura, RA. (2002). "Cardiology patient pages. Aortic valve disease.". Circulation. 106 (7): 770–2. PMID 12176943. 
  3. 3.0 3.1 Lebowitz NE, Bella JN, Roman MJ, Liu JE, Fishman DP, Paranicas M, Lee ET, Fabsitz RR, Welty TK, Howard BV, Devereux RB (2000). "Prevalence and correlates of aortic regurgitation in American Indians: the Strong Heart Study". Journal of the American College of Cardiology. 36 (2): 461–7. PMID 10933358. Retrieved 2011-03-02. 
  4. 4.0 4.1 Dujardin KS, Enriquez-Sarano M, Schaff HV, Bailey KR, Seward JB, Tajik AJ (1999). "Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study". Circulation. 99 (14): 1851–7. PMID 10199882. Retrieved 2011-03-02. 
  5. 5.0 5.1 Ortiz JT, Shin DD, Rajamannan NM (2006). "Approach to the patient with bicuspid aortic valve and ascending aorta aneurysm". Current Treatment Options in Cardiovascular Medicine. 8 (6): 461–7. PMID 17078910. 
  6. 6.0 6.1 Keane MG, Pyeritz RE (2008). "Medical management of Marfan syndrome". Circulation. 117 (21): 2802–13. PMID 18506019. doi:10.1161/CIRCULATIONAHA.107.693523. Retrieved 2011-04-13. 
  7. Seckeler MD, Hoke TR (2011). "The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease". Clinical Epidemiology. 3: 67–84. PMC 3046187Freely accessible. PMID 21386976. doi:10.2147/CLEP.S12977. 
  8. Bekeredjian, R.; Grayburn, PA. (2005). "Valvular heart disease: aortic regurgitation.". Circulation. 112 (1): 125–34. PMID 15998697. doi:10.1161/CIRCULATIONAHA.104.488825. 


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