OBJECTIVES: To analyze sex and age distribution of global disease burden of calcific aortic valve disease (CAVD) from 1990 to 2021. METHODS: CAVD data during 1990-2021 were obtained from the IHME website for Global Burden of Disease (GBD). The prevalence, mortality, years lived with disability (YLDs), and disability-adjusted life years (DALYs) were analyzed by gender and age groups. Joinpoint regression was used to calculate annual percentage change (APC) and average annual percentage change (AAPC). RESULTS: In 2021, there were 13.32 million CAVD patients and 142 000 deaths caused by CAVD globally. Age-standardized prevalence was higher in males (193.2/10⁵) than that in females (128.9/10⁵). Patients in 65-<85 age group accounted for 64.0% of total cases, while those ≥85 years old accounted for 16.1%. From 1990 to 2021, prevalence increased in both sexes with an AAPC of 0.72% for males and 0.57% for females, respectively. Prevalence grew fastest from 2000 to 2010, slowed thereafter, and declined from 2015 to 2021. In <65 years old, the mortality of males was 2.4 times higher than that of females, while in ≥85 years old, mortality of females (117.3/10⁵) exceeded that of males (99.1/10⁵). YLD rates increased with age, and were higher in males for all age groups. DALY rates decreased overall but increased in ≥85 years old, with a greater increase in females. CONCLUSIONS There are significant gender and age disparities in global disease burden of CAVD, with the elderly, especially super-elderly females deserving particular attention. It is recommended to develop personalized intervention strategies for these populations.
Humans ; Male ; Female ; Aged ; Calcinosis/mortality* ; Prevalence ; Global Burden of Disease ; Aged, 80 and over ; Middle Aged ; Aortic Valve/pathology* ; Aortic Valve Stenosis/epidemiology* ; Age Distribution ; Adult ; Disability-Adjusted Life Years ; Sex Distribution ; Global Health ; Aortic Valve Disease/epidemiology* ; Sex Factors

BACKGROUNDAngina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis (AS), even in patients without significant coronary artery disease (CAD). However, the incidence of angina pectoris and related CAD in such patients is controversial. There is continuing debate as to whether coronary angiography is necessary before aortic valve replacement (AVR) in patients with severe AS. The purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean population.

METHODSData from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in 1995. Clinical and echocardiographic follow-up data were recorded into the database annually. Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography. We excluded patients with multiple valve disease, significant aortic regurgitation, or prior CAD or valve surgery.

RESULTSTotally 574 patients with severe AS (mean age, (65.9±9.6) years) were enrolled in this study. Significant CAD was found in 61 patients (10.6%). Factors associated with increased likelihood of CAD were age, hypertension, diabetes mellitus, chronic renal failure, carotid disease, and aorta calcification. In Logistic regression analysis, the independent predictor of the presence of CAD was age (P = 0.011). The incidence of CAD increased significantly at 69.2 years of age. Having two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant CAD.

CONCLUSIONSThere was a low incidence of significant CAD in a population of Korean patients with severe AS. Therefore, coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than 69 years of age without risk factors for cardiovascular disease.

Aged ; Angina Pectoris ; diagnosis ; epidemiology ; Aortic Valve ; surgery ; Aortic Valve Stenosis ; epidemiology ; surgery ; Coronary Angiography ; Coronary Artery Disease ; diagnosis ; epidemiology ; Echocardiography ; Humans ; Incidence ; Middle Aged