Stages of Valvular Heart Disease among Older Adults in the Community: The Atherosclerosis Risk in Communities Study

Khaled Shelbaya, Brian Claggett, Pranav Dorbala, Hicham Skali, Scott D. Solomon, Kunihiro Matsushita, Suma Konety, Thomas H. Mosley, Amil M. Shah

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)638-649
Number of pages12
Issue number8
StatePublished - Feb 21 2023

Bibliographical note

Funding Information:
The ARIC study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under contracts HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. This work was also supported by National Institutes of Health/National Heart, Lung, and Blood Institute grants R01HL135008 (Dr Shah), R01HL143224 (Dr Shah), R01HL150342 (Dr Shah), R01HL148218 (Dr Shah), R01HL160025 (Dr Shah), and K24HL152008 (Dr Shah). The funder had no role design and conduct of this study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funding Information:
Dr Shah reports consulting fees from Philips Ultrasound and Janssen and research funds from Novartis through Brigham and Women’s Hospital. Dr Skali reports consulting fees from Astellas Inc and research support from ABT Associates. The other authors report no conflicts.

Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.


  • aged
  • cohort studies
  • echocardiography
  • guidelines as topic
  • heart valve diseases

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


Dive into the research topics of 'Stages of Valvular Heart Disease among Older Adults in the Community: The Atherosclerosis Risk in Communities Study'. Together they form a unique fingerprint.

Cite this