The Evolving Epidemiology of Elderly with Degenerative Valvular Heart Disease: The Guangzhou (China) Heart Study

Abstract

Aim. The present study was aimed at investigating the prevalence, incidence, progression, and prognosis of degenerative valvular heart disease (DVHD) in permanent residents aged ≥65 years from Guangzhou, China. Methods. This was a prospective study based on community population. Over a 3-year span, we conducted repeated questionnaires, blood tests, and echocardiographic and electrocardiogram examinations (2018) of a random sample of initially 3538 subjects. Results. The prevalence of DVHD increased with age, average values being 30.6%, 49.2%, and 62.9% in 65-74, 75-84, and ≥85 years of age, respectively. The incidence rate was 1.7%/year. Aortic stenosis was the result of DVHD, and the mean transvalvular pressure gradient increased by 5.6 mmHg/year. The increase of mild aortic stenosis was lower than that of more severe disease, showing a nonlinear development of gradient, but with great individual variations. Mortality was significantly increased in the DVHD group ( $\text{HR}=2.49$ ). Risk factors for higher mortality included age ( ${\chi }^2=1.9$ , $P<0.05$ ), renal insufficiency ( ${\chi }^2=12.5$ , $P<0.01$ ), atrial fibrillation ( ${\chi }^2=12.2$ , $P<0.01$ ), mitral regurgitation ( ${\chi }^2=1.8$ , $P<0.05$ ), and tricuspid regurgitation ( ${\chi }^2=6.7$ , $P<0.05$ ) in a DVHD population. Conclusions. DVHD was highly prevalent among residents in southern China. With the progression of the disease, the mean transvalvular pressure gradient accelerated. DVHD was an independent predictor of death, and the mortality was higher in those with older age, renal insufficiency, atrial fibrillation, mitral regurgitation, and tricuspid regurgitation.