BACKGROUND:Limited data exist on American College of Cardiology/American Heart Association valvular heart disease (VHD) stage prevalence, progression, and association with incident cardiovascular diseases in late life.METHODS:Participants in the ARIC study (Atherosclerosis Risk in Communities), a prospective community-based cohort study, underwent protocol echocardiography at ARIC visits 5 (2011–2013) and 7 (2018–2019), and their aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation stage were defined according to American College of Cardiology/American Heart Association guidelines. The overall VHD stage prevalence at visit 5 was measured. The associations between VHD stages and incident adjudicated death, heart failure, coronary heart disease, stroke, and atrial fibrillation were assessed with Cox proportional hazard models adjusted for age, sex, race, hypertension, diabetes, prior myocardial infarction, heart failure, body mass index, study center, systolic blood pressure, estimated glomerular filtration rate, and low-density lipoprotein at visit 5. Longitudinal changes in VHD stage prevalence over ≈6 years were estimated with inverse probability of attrition weights to account for participant attrition.RESULTS:Among 6118 ARIC participants, the mean±SD age was 76±5 years, 42% were male, and 22% reported Black race. Stage A VHD was present in 39%, stage B in 17%, and stage C/D in 1.1%;, 0.7% had previously undergone valve replacement or repair. A graded association was observed between stage A, B, and C/D VHD and risk of all-cause mortality, incident heart failure, incident atrial fibrillation, and incident coronary heart disease, but not incident stroke. Similar findings were observed for stages of each valvular lesion individually. During the 6.6 years (interquartile range, 6.1–7.0 years) between visits 5 and 7 (mean age, 81±4 years), the prevalence of freedom from VHD stage decreased from 43% to 24%, whereas the prevalence of stage C/D VHD increased from 1% to 7%.CONCLUSIONS:Subclinical VHD is common in older adults, with 39% at risk (stage A) and 17% with progressive VHD (stage B), and is independently associated with risk of incident cardiovascular events. VHD stages progress over 6 years in late life, with a several-fold increase in prevalence of severe VHD (stage C/D), highlighting the public health importance of interventions to mitigate VHD progression.

中文翻译：

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社区老年人瓣膜性心脏病的各个阶段：社区研究中的动脉粥样硬化风险


背景：关于美国心脏病学会/美国心脏协会瓣膜性心脏病 (VHD) 阶段的患病率、进展以及与晚年心血管​​疾病事件的关系的数据有限。 方法：ARIC 研究（社区动脉粥样硬化风险）的参与者，基于社区的前瞻性队列研究，在 ARIC 第 5 次（2011-2013 年）和第 7 次（2018-2019 年）就诊时接受了超声心动图检查，并根据美国心脏病学会定义了主动脉瓣狭窄、主动脉瓣关闭不全、二尖瓣狭窄和二尖瓣关闭不全阶段/美国心脏协会指南。测量第 5 次就诊时的总体 VHD 阶段患病率。使用针对年龄、性别、种族、高血压、糖尿病、既往心肌梗死、心力衰竭、体重进行调整的 Cox 比例风险模型评估 VHD 分期与事件判定死亡、心力衰竭、冠心病、中风和心房颤动之间的关联指数、研究中心、收缩压、估计肾小球滤过率和第 5 次访视时的低密度脂蛋白。约 6 年内 VHD 阶段患病率的纵向变化通过磨损权重的逆概率进行估计，以解释参与者的磨损。结果：其中6118 名 ARIC 参与者，平均±SD 年龄为 76±5 岁，42% 为男性，22% 为黑人种族。 A 期 VHD 占 39%，B 期占 17%，C/D 期占 1.1%；0.7% 之前接受过瓣膜置换或修复。 A、B 和 C/D 期 VHD 与全因死亡、心力衰竭、心房颤动和冠心病风险之间存在分级关联，但与卒中风险无关。对于每个瓣膜病变的各个阶段也观察到类似的结果。 在第 5 次就诊和第 7 次就诊之间的 6.6 年（四分位距，6.1-7.0 岁）期间（平均年龄，81±4 岁），摆脱 VHD 阶段的患病率从 43% 下降到 24%，而 C/ 阶段的患病率D VHD 从 1% 增加至 7%。结论：亚临床 VHD 在老年人中很常见，39% 的人处于危险之中（A 期），17% 的人患有进行性 VHD（B 期），并且与心血管事件的风险独立相关。 VHD 分期在晚年 6 年内进展，严重 VHD（C/D 期）患病率增加数倍，凸显了减缓 VHD 进展干预措施对公共卫生的重要性。