Epidemiology and cardiovascular risk factors of aortic stenosis

Login or register to view PDF.

The abnormalities of aortic valve morphology and function represent the most common cardiac-valve lesion particularly in elderly. The etiology of aortic stenosis is degenerative-calcific in the majority of patients. Many risk factors seems to be linked to the calcification and the stenosis of the aortic valve but they must be confirmed. In this review the etiology and the possible physiopathology of the aortic valve stenosis is discussed.


The abnormalities of aortic valve morphology and function represent the most common cardiac-valve lesion, with relevant implications both for medical and surgical treatment. Particularly, the aortic valve sclerosis (aortic valve thickening and calcification without pressure gradient) seem to affect about one fourth of adults over 65 years of age, while the aortic valve stenosis is present in 2├óÔé¼ÔÇ£9% of general population over 65 years of age; an increased prevalence of both sclerosis and stenosis with aging (48% and 4% in those over 85 years) is observed. Furthermore, the number of the aortic valve procedures performed over the last 10 years is increasing if we consider the aortic valve replacement alone or combined with myocardial revascularization; mitral valve surgery seems to be constant in the same period. Also, the etiology of the pathologic process of the aortic valve is changing in the last years. Passik et al. analysed the valve characteristics in 646 patients with pure aortic stenosis who underwent valve replacement between 1981 and 1985 at Mayo Clinic. During the five years of the study, the relative frequency of the postinflammatory disease (i.e. post-rheumatic) decreased from 30% to 18% and the relative frequency of the bicuspid aortic valve changed from 37% to 33%; in contrast, the relative frequency of degenerative-calcific aortic stenosis (an \atherosclerotic\" form of disease, see below) increased from 30% to 46%. These differences were striking in subjects older than 70 years [1].

Several studies have been published in the last years which clarify the epidemiology of valvular disease and, specifically, of aortic valve disease. In the The EuroHeart Failure survey programme, a survey on the quality of care among patients with heart failure in Europe, of 46.788 patients screened over a six-week period 11.327 (24%) patients were enrolled with a suspected or confirmed heart failure; a valve disease was the cause of heart failure in 29% of the cases, compared with coronary artery disease in 68% and idiopathic dilated cardiomyopathy in 6% [2]. In the Euro-Heart Survey of acute coronary syndromes, 489 out of 10207 (4.8%) patients with acute coronary syndromes enrolled had a significant valve disease. The more common abnormalities were ischemic mitral regurgitation and calcific aortic stenosis. The patients with valve disease were older, more likely females and with comorbidities such as diabetes and chronic renal failure; they more likely have had a prior CHF and LV dysfunction, cardiac ischemic event or revascularization. In-hospital and 30-day mortality of the patients with valve disease were significantly higher than those without (13.4% and 15.5% versus 6.4% and 7.7%, respectively) [3].


  1. Passik CS, Ackermann DM, Pluth JR, Edwards WD: Temporal changes in the causes of aortic stenosis: a surgical pathologic study of 646 cases. Mayo Clin Proc 1987, 62:119.
  2. Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, Dietz R, Gavazzi A, Hobbs R, Korewicki J, Madeira HC, Moiseyev VS, Preda I, van Gilst WH, Widimsky J, Freemantle N, Eastaugh J, Mason J: Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology. The EuroHeart Failure survey programme- a survey on the quality of care among patients with heart failure in Europe. Eur Heart J 2003, 24:442.
  3. Hasdai D, Lev EI, Behar S, Boyko V, Danchin N, Vahanian A, Battler A: Acute coronary syndromes in patients with pre-existing moderate to severe valvular disease of the heart: lessons from the Euro-Heart Survey of acute coronary syndromes. Eur Heart J 2003, 24:623.
  4. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A: A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 2003, 24:1231.
  5. Lindroos M, Kupari M, Heikkila J, Tilvis R: Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol 1993, 21:1220.
  6. Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM: Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol 1997, 29:630.
  7. Brown M, Palmer C, Castaigne A, De Leeuw P, Mancia G, Rosenthal T, Ruilope L: Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT). The Lancet 2000, 356:366.
  8. Olsen MH, Wachtell K, Bella JN, Liu JE, Boman K, Gerdts E, Papademetriou V, Nieminen MS, Rokkedal J, Dahl─é┬Âf B, Devereux RB: Effect of losartan versus atenolol on aortic valve sclerosis (a LIFE substudy). The Am J Cardiol 2004, 94:1076.
  9. Branch KR, O'Brien KD, Otto CM: Aortic valve sclerosis as a marker of active atherosclerosis. Curr Cardiol Rep 2002, 4:111.
  10. Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS: The Cardiovascular Health Study. Association of Aortic-Valve Sclerosis with Cardiovascular Mortality and Morbidity in the Elderly. N Engl J Med 1999, 341:142.
  11. Roberts WC: The senile cardiac calcification syndrome. Am J Cardiol 1986, 58:572.
  12. Fox CS, Vasan RS, Parise H, Levy D, O'Donnell CJ, D'Agostino RB, Benjamin EJ: Mitral Annular Calcification Predicts Cardiovascular Morbidity and Mortality: The Framingham Heart Study. Circulation 2003, 107:1492.
  13. Faggiano P, D'Aloia A, Antonini-Canterin F, Pinamonti B, DiLenarda A, Brentana L, Metra M, Nodari S, Dei Cas L: Usefulness of cardiac calcification on two-dimensional echocardiography for distinguishing ischemic from nonischemic dilated cardiomyopathy: a preliminary report. J Cardiovasc Med 2006, in press.
  14. Faggiano P, Aurigemma GP, Rusconi C, Gaasch WH: Progression of valvular aortic stenosis in adults: literature review and clinical implications. Am Heart J 1996, 132:408.
  15. Yee-Moon Wang A, Wang M, Woo J, Wai-Kei Lam C, Kam-Tao Li P, Lui SF, Sanderson JE: Cardiac Valve Calcification as an Important Predictor for All-Cause Mortality and Cardiovascular Mortality in Long-Term Peritoneal Dialysis Patients: A Prospective Study. J Am Soc Nephrol 2003, 14:159.
  16. Faggiano P, Antonini-Canterin F, Erlicher A, Romeo C, Cervesato E, Pavan D, Piazza R, Huang G, Nicolosi GL: Progression of aortic valve sclerosis to aortic stenosis. Am J Cardiol 2003, 91:99.
  17. Antonini-Canterin F, Popescu BA, Huang G, Korcova-Miertusova R, Rivaben D, Faggiano P, Pavan D, Piazza R, Bolis A, Ciavattone A, Ruggiero A, Nicolosi GL: Progression of aortic valve sclerosis and aortic valve stenosis: what is the role of statin treatment? Ital Heart J 2005, 6:119.