Valvular heart disease (VHD) is a major contributor to loss of physical function, quality of life and longevity. The epidemiology of VHD varies substantially around the world, with a predominance of functional and degenerative disease in high-income countries, and a predominance of rheumatic heart disease in low-income and middle-income countries. Reflecting this distribution, rheumatic heart disease remains by far the most common manifestation of VHD worldwide and affects approximately 41 million people. By contrast, the prevalence of calcific aortic stenosis and degenerative mitral valve disease is 9 and 24 million people, respectively. Despite a reduction in global mortality related to rheumatic heart disease since 1900, the death rate has remained fairly static since 2000. Meanwhile, deaths from calcific aortic stenosis have continued to rise in the past 20 years. Epidemiological data on other important acquired and congenital forms of VHD are limited. An ageing population and advances in therapies make an examination of the changing global epidemiology of VHD crucial for advances in clinical practice and formulation of health policy. In this Review, we discuss the global burden of VHD, geographical variation in the presentation and clinical management, and temporal trends in disease burden.

瓣膜性心脏病 (VHD) 是导致身体功能、生活质量和寿命丧失的主要原因。 VHD 的流行病学在世界各地差异很大，高收入国家以功能性和退行性疾病为主，低收入和中等收入国家以风湿性心脏病为主。反映这种分布的是，风湿性心脏病迄今为止仍然是全世界 VHD 最常见的表现，影响着大约 4100 万人。相比之下，钙化性主动脉瓣狭窄和退行性二尖瓣疾病的患病率分别为 9 人和 2400 万人。尽管自 1900 年以来全球与风湿性心脏病相关的死亡率有所下降，但自 2000 年以来死亡率一直保持相当稳定。与此同时，钙化性主动脉瓣狭窄的死亡人数在过去 20 年中持续上升。其他重要的获得性和先天性 VHD 形式的流行病学数据有限。人口老龄化和治疗方法的进步使得对不断变化的 VHD 全球流行病学的研究对于临床实践的进步和卫生政策的制定至关重要。在这篇综述中，我们讨论了 VHD 的全球负担、表现和临床管理的地理差异以及疾病负担的时间趋势。