The extensive presence of undiagnosed heart valve disease in our ageing population has come to light through pioneering research spearheaded by the University of East Anglia. The study reveals that more than 25% of asymptomatic individuals over the age of 60 were found to harbour undiagnosed heart valve disease.
Vassilios Vassiliou, the co-lead author and Clinical Professor of Cardiac Medicine at UEA’s Norwich Medical School, remarked that the research aimed to gauge the prevalence of varying severity of heart valve complications among healthy, symptom-free adults with no history of heart conditions. Nearly 4,500 participants aged 60 and above from Norfolk, West Midlands, and Aberdeen were assessed using echocardiography, a type of heart ultrasound. The results indicated that upwards of 28% of these individuals had some form of heart valve disease. Thankfully, the majority of these cases were mild.
The study underscored age as a primary factor linked to heart valve issues, illustrating that the likelihood of significant valve problems escalates. Heart valves play a crucial role in cardiovascular health, acting like gates that govern blood flow in one direction through the heart, much like a one-way traffic system. The four valves—the pulmonary and tricuspid on the right side and the aortic and mitral on the left side of the heart—ensure that blood is pumped efficiently.
Professor Michael Frenneaux, co-lead author and a prominent figure at the Royal Brompton Hospital, part of Guy’s and St Thomas’ NHS Foundation Trust and Imperial College London, explained that heart valve disease occurs when these valves fail to function correctly. The principal issues include valve stenosis, which doesn’t open fully, hindering blood flow, and valve regurgitation, which doesn’t close completely, allowing blood to leak backwards. These conditions can significantly strain the heart and elevate the risk of serious cardiac events like heart attacks and strokes.
Symptoms of heart valve disease can range from breathlessness, chest pain, and palpitations to fatigue, dizziness, and swelling of the ankles and feet. From 2007 to 2016, over 10,000 asymptomatic patients above 60 were invited to participate in this British Heart Foundation-funded study, with 5,429 volunteering and 4,237 being eligible for inclusion. Participants underwent health questionnaires, clinical examinations, and transthoracic echocardiography. The prevalence of heart valve disease was diagnosed at 28.2%, though only 2.4% had clinically significant valvular disease, with moderate or severe cases more frequent in those aged 75 and older.
Prof. Vassiliou highlighted the challenges in diagnosing heart valve disease, which is often only performed after detecting symptoms or an unusual heart murmur during physical exams. This is particularly tricky in older adults, where mild symptoms might be obscured by reduced physical activity and mobility issues.
The study underscores the latent prevalence of heart valve issues in older adults, even without symptoms. It suggests the importance of discussing new symptoms that might indicate heart disease with a healthcare provider. As the population ages, these insights will be crucial for healthcare providers to understand the extent of valve disease and optimize routine care and screening programs to meet future demands. This proactive approach aims to identify and assist those at risk before their conditions worsen.
Further research is essential to determine the exact prevalence of this condition in the elderly and to explore how screening might be employed to detect and manage the disease effectively. James Leiper, Associate Medical Director at the British Heart Foundation, emphasized the importance of this research in uncovering heart valve conditions in a large group of asymptomatic individuals. He noted that while significant progress has been made, ongoing research is vital to continue developing methods for disease identification and ultimately to reduce the burden of heart disease.
More information: Vasiliki Tsampasian et al, Prevalence of asymptomatic valvular heart disease in the elderly population: a community-based echocardiographic study, European Heart Journal – Cardiovascular Imaging. DOI: 10.1093/ehjci/jeae127
Journal information: European Heart Journal – Cardiovascular Imaging Provided by University of East Anglia
