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The prevalence of aortic stenosis in the elderly in Iceland and predictions for the coming decades: The AGES–Reykjavík study
Open accessAbstract
Aims To evaluate the prevalence of significant aortic valve stenosis (AS) in a randomly selected study population of elderly individuals representing the general population of Iceland. Furthermore, to predict the number of individuals likely to have severe AS in the future.Methods and results Echocardiography and computed tomography (CT) data from individuals who participated in the AGES-Reykjavik study were used. Echocardiography data from 685 individuals (58% females) aged 67-95 years were available. In both sexes combined, the prevalence for severe AS, defined as an aortic valve area index of <0.6 cm2/m2, in the age groups<70, 70-79 and ≥80 years was 0.92%, 2.4% and 7.3%, respectively. A ROC analysis on the relation between the echocardiography data and the aortic valve calcium score on CT defined a score≥500 to be indicative of severe AS. Subsequently, in a CT study cohort of 5256 individuals the prevalence of severe AS in the same age groups was 0.80%, 4.0% and 9.5%, respectively. Overall, the prevalence of severe AS by echocardiography and CT in individuals≥70 years was 4.3% and 5.9%, respectively. A prediction on the number of elderly≥70 years for the coming decades demonstrated that patients with severe AS will have increased 2.4 fold by the year 2040 and will more than triple by the year 2060.Conclusion This study, in a cohort of elderly individuals representative of the general population in a Nordic country, predicts that AS will be a large health problem in the coming decades.
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“Estimates based on current prevalence rates and demographic forecasts predict that the number of patients with calcific AS >70 or >75 years of age will increase twofold to threefold over the next 50 years in developed countries15;16;19.”
From Calcific aortic stenosis (2016) · cites this paper as [15]
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“The burden of calcific AS in the community is expected to increase over the next decades owing to population aging and the lack of a prevention strategy aimed at reducing disease progression.”
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“In individuals over 75 years, the prevalence of AS is 10%–15% but is expected to more than double by 2040.(2) Although a replacement of the aortic valve is effective for severe AS cases,(3,4) there are no treatments to prevent progression to valve replacement.”
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“Showing an increasing incidence with age and considering the demographic changes in the near future, it may become an epidemic disease.(1) The AVS progresses over several years until symptoms such as exertional dyspnea, angina, and syncopes develop.”
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“Aging population projections estimate a continued increase in the number of people >75 years in the coming decades, which will increase the prevalence of AS to more than double [4].”
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“It is also notable that increased prevalence with aging was observed in both DMS (Table 2) and degenerative AS [19].”
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Patterns of Aortic Valve Replacement in Europe: Adoption by Age
Rudolph, T. K., Appleby, C. E., Delgado, V., Eltchaninoff, H., Gebhard, C., Hengstenberg, C., Wojakowski, W., Petersen, N., Kurucova, J., Bramlage, P., et al. (2023) · Cardiology · doi:10.1159/000533633 · Cited by 13
“The AGES-Reykjavik found a prevalence of severe AS (diagnosed by AV area measured with echocardiography) of 2.4% at age 70 – 79 years, which increased steeply to 7.3% at age > 80 years [37].”
BackgroundInfluentialDeep Learning-enabled Detection of Aortic Stenosis from Noisy Single Lead ElectrocardiogramsPreprint
Aminorroaya, A., Dhingra, L. S., Sangha, V., Oikonomou, E. K., Khunte, A., Shankar, S. V., Pedroso, A. F., Haynes, N., Hofer, I. S., Ouyang, D., et al. (2023) · medRxiv · doi:10.1101/2023.09.29.23296310 · Cited by 13
Song, Q., Liu, R., Yang, K., Tu, X., Tan, H., Fan, C., & Li, X. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.125.041283 · Cited by 13
“33 Future studies should focus on the elderly populations.”
Popat, A., Saini, B., Patel, M., Seby, N., Patel, S., Harikrishnan, S., Shah, H. N. H., Pathak, P., Dekhne, A., Sen, U., et al. (2024) · Clinical Medicine & Research · doi:10.3121/cmr.2024.1934 · Cited by 12
Solache-Berrocal, G., Barral-Varela, A. M., Areces-Rodríguez, S., Junco-Vicente, A., Vallina-Álvarez, A., Corte-Torres, M. D., Valdivielso, J. M., Llosa, J. C., Morı́s, C., Martı́n, M., et al. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm9010029 · Cited by 12
“For instance, a study has predicted that the number of individuals with severe aortic stenosis in Iceland may triple by the year 2060 [2].”
BackgroundStrom, J. B., Xu, J., Sun, T., Song, Y., Sevilla-Cazes, J., Almarzooq, Z., Markson, L. J., Wadhera, R. K., & Yeh, R. W. (2022) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.122.009162 · Cited by 12
Dimitriadis, K. S., Pyrpyris, N., Aznaouridis, K. A., Σουλαϊδόπουλος, Σ., Koutsopoulos, G., Beneki, E., Tatakis, F., Adamopoulou, E., Tsioufis, P., DeBiase, C., et al. (2025) · Journal of Cardiology · doi:10.1016/j.jjcc.2025.06.022 · Cited by 11
Impact of severe aortic stenosis on quality of life
Gracia-Baena, J. M., Marsal, J. R., Cardeñosa, S. L., Vall, I. C., Zielonka, M. Z., & Godoy, P. (2023) · PLoS ONE · doi:10.1371/journal.pone.0287508 · Cited by 11
Arrieta, V., Sádaba, R., Álvarez, V., Rodríguez, J. A., & López‐Andrés, N. (2019) · Anales del Sistema Sanitario de Navarra · doi:10.23938/assn.0643 · Cited by 10
Khurrami, L., Møller, J. E., Lindholt, J. S., Dahl, J. S., Fredgart, M. H., Obel, L. M., Steffensen, F. H., Urbonavičienė, G., Lambrechtsen, J., & Diederichsen, A. C. P. (2021) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jeab182 · Cited by 12
“Few studies have assessed the association of AVC detected on NCCT with echocardiographic findings in the general population.(13,14) The objectives of this study were to describe the association between AVC score and echocardiographic findings of left atrial (LA) dilatation, left ventricular (LV) hypertrophy, aortic va…”
BackgroundChung, Y. H., Lee, S. H., Ko, Y., Lee, S., Shim, C. Y., Ahn, C., Hong, G., Shim, J., Kwak, Y. L., & Hong, M. (2021) · Yonsei Medical Journal · doi:10.3349/ymj.2021.62.10.885 · Cited by 11
“Aortic stenosis (AS) is the most common degenerative heart valve disease in older adults.(1) Conventional surgical aortic valve replacement (SAVR) has been the gold standard for treating symptomatic severe AS.”
BackgroundKarakasis, P., Patoulias, D., Giannakoulas, G. A., Sagris, Μ., Theofilis, P., Fragakis, N., & Biondi‐Zoccai, G. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13216411 · Cited by 12
Future prospects in the tissue engineering of heart valves: a focus on the role of stem cells
Albert, B. J., & Butcher, J. T. (2023) · Expert Opinion on Biological Therapy · doi:10.1080/14712598.2023.2214313 · Cited by 8
“patients with calcific aortic valve disease is projected to double [5,6].”
BackgroundEpidemiology of heart valve disease
Huntley, G. D., Thaden, J. J., & Nkomo, V. T. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814661-3.00003-4 · Cited by 11
Coronary Artery Disease in Patients Undergoing Transvalvular Aortic Valve Implantation
Lim, Y., Tan, K. A., Kuntjoro, I., Hon, J. K. F., Yip, J., & Tay, E. L. W. (2022) · Interventional Cardiology Reviews Research Resources · doi:10.15420/icr.2021.25 · Cited by 9
Khurrami, L., Møller, J. E., Dahl, J. S., Carter‐Storch, R., Christensen, N. L., Pareek, M., Lindholt, J. S., & Diederichsen, A. C. P. (2020) · International journal of cardiac imaging · doi:10.1007/s10554-020-02012-2 · Cited by 10
Aortic valve stenosis and cancer: a common and complex association
Frattini, S., Troise, G., Fucci, C., Pressman, G. S., & Faggiano, P. M. (2021) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2021.1902306 · Cited by 9
Valerio, V., Keceli, G., Moschetta, D., Porro, B., Ciccarelli, M., Massaiu, I., Songia, P., Maione, A. S., Alfieri, V., Myasoedova, V. A., et al. (2022) · Antioxidants and Redox Signaling · doi:10.1089/ars.2021.0133 · Cited by 9
“Despite severe AS being estimated to march up by 2.4-fold in the year 2040 and likely to escalate more than triple by 2060 (17), no current effective pharmacological treatment for preventing or arresting CAVS progression is available at the moment, therefore resting on surgical or transcatheter AVR…”
InfluentialPerego, S., Zambon, A., Nistri, S., Bruni, A. A., Motta, S., d’Oro, L. C., Rossi, E., Annoni, G., & Bellelli, G. (2020) · Aging Clinical and Experimental Research · doi:10.1007/s40520-020-01471-w · Cited by 9
“7%, according to age and methods used to define AS (echocardiography or computed tomography) [23-25].”
MethodRacial and Ethnic Differences in the Prevalence of Severe Aortic Stenosis by Echocardiography
Allahwerdy, S., Xie, F., Zhou, B., Wu, Y., Wessler, B. S., Chen, W., & Lee, M. S. (2024) · The Permanente Journal · doi:10.7812/tpp/24.038 · Cited by 8
“9,10 13 These studies have been limited by the relatively small cohort size, biased ascertainment of aS by reliance on hospitalization data or claims data, and referral bias from data obtained from academic tertiary-care centers.”
BackgroundPlasma Proteomic Assessment of Calcific Aortic Valve Disease in Older Adults
Bortnick, A. E., Austin, T. R., Hamerton, E., Guðmundsdóttir, V., Emilsson, V., Jennings, L. L., Gudnason, V. G., Owens, D. S., Massera, D., Dufresne, L., et al. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.124.036336 · Cited by 8
Self-citationKontogeorgos, S., Rosengren, A., Sandström, T. Z., Fu, M. L. X., Lindgren, M., Basic, C., Svanvik, T., Djekic, D., & Thunström, E. Ö. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.034891 · Cited by 8
Growing prevalence of aortic stenosis – Question of age or better recognition?
Chatterjee, A., Kazui, T., & Acharya, D. (2023) · International Journal of Cardiology · doi:10.1016/j.ijcard.2023.131155 · Cited by 8
Navigating the silence: reconsidering treatment paradigms in asymptomatic severe aortic stenosis
Karampinos, K. I., Ktenopoulos, N., Apostolos, A., Koliastasis, L., Kachrimanidis, I., Vlachakis, P. K., Katsaros, O., Tsalamandris, S., Καρανάσος, Α., Drakopoulou, M. I., et al. (2025) · Hellenic Journal of Cardiology · doi:10.1016/j.hjc.2025.06.004 · Cited by 7
Baran, J., Podolec, J., Tomala, M. T., Nawrotek, B., Niewiara, Ł., Gackowski, A., Przewłocki, T., Zmudka, K. F., & Kabłak-Ziembicka, A. (2018) · Advances in Interventional Cardiology · doi:10.5114/aic.2018.78331 · Cited by 7
“As a result of global population aging, a rapid increase in the incidence of DAS is noted [5, 6].”
BackgroundDou, Z., Lai, X., Zhong, X., Hu, S., Shi, Y., & Jia, J. (2024) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2024.105700 · Cited by 6
Murthi, M., Velagapudi, S., Sharma, B., Akuna, E., Ezegwu, O., Park, D. Y., Atluri, R., & Vardar, U. (2022) · Cureus · doi:10.7759/cureus.24534 · Cited by 6
“3% of adults over 75 years of age having severe aortic stenosis [2,3].”
BackgroundIntroduction and general comments
Iung, B., & Kappetein, A. P. (2018) · doi:10.1093/med/9780198784906.003.0764 · Cited by 6
Cardiovascular Disease in the Oldest Old: A Geriatric Epidemiology Perspective
Bari, M. D., & Balzi, D. (2017) · Springer eBooks · doi:10.1007/978-3-319-43468-1_2 · Cited by 6
Current Management and Therapy of Severe Aortic Stenosis and Future Perspective
Takeji, Y., Tada, H., Taniguchi, T., Sakata, K., Kitai, T., Shirai, S., & Takamura, M. (2024) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.rv22023 · Cited by 5
“Severe AS occurs in ＜ 1% of individuals ＜ 70 years old, but the incidence increases to about 7% among those ≥ 80 years old 2-4 ) .”
BackgroundIntorcia, A., Ambrosini, V., Capasso, M., Granata, R., Magliulo, F., Carbone, G. L., Capobianco, S., Rotondi, F., Lanni, F., Manganelli, F., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19084763 · Cited by 5
“It is a degenerative disease with a prevalence of >7% among patients aged >80 years [2].”
BackgroundThe Role of NOTCH Pathway Genes in the Inherited Susceptibility to Aortic Stenosis
Irtyuga, O. B., Skitchenko, R. K., Babakekhyan, M., Usoltsev, D., Tarnovskaya, S. I., Malashicheva, A., Fomicheva, Y. V., Rotar, O., Моисеева, О. М., Shadrina, U., et al. (2024) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd11070226 · Cited by 5
Metzler, S. A., Waller, S. C., & Warnock, J. N. (2018) · Cardiovascular Engineering and Technology · doi:10.1007/s13239-018-00375-1 · Cited by 5
Intraleaflet Hemorrhage and Iron-Dependent Pathomechanisms in Calcific Aortic Valve Disease
Deutsch, M.-A., & Gummert, J. F. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.12.041 · Cited by 5
Augmentation index predicts mortality in patients with aortic stenosis: an echo-tracking study
Vriz, O., Palatini, P., Mos, L., Alsergani, H., Vendramin, I., Livi, U., Antonini‐Canterin, F., & Magné, J. (2021) · International journal of cardiac imaging · doi:10.1007/s10554-020-02151-6 · Cited by 5
Nashimoto, S., Inoue, T., Hotta, K., Sugito, Y., Iida, S., & Tsubaki, A. (2022) · Physiological Reports · doi:10.14814/phy2.15272 · Cited by 5
“The incidence of aortic stenosis (AS), which increases with age, is a serious problem in an aging society (Danielsen et al., 2014; De Sciscio et al., 2017; Durko et al., 2018; Eveborn et al., 2013; Nkomo et al., 2009).”
BackgroundAbraham, B., Farina, J., Fath, A. R., Abdou, M. M., Elbanna, M., Suppah, M., Sleem, M., Eldaly, A. S., Aly, M., Megaly, M. S., et al. (2023) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.30676 · Cited by 5
Alman, K. J., Sadd, C. J., Raval, A. N., Raza, F., Chybowski, A., & Runo, J. R. (2022) · Pulmonary Circulation · doi:10.1002/pul2.12118 · Cited by 5
“and older and an incidence of new AS of 5 per 1000 per year with 60 years being the initial mean age of participants.(14) In our study cohort, however, greater than 50% of patients diagnosed with AS were under the age of 70.”
BackgroundInsights into preclinical models of calcific aortic valve disease and their translational potential
Lafosse, I., Mentaverri, R., Avondo, C., Bennis, Y., Tribouilloy, C. M., & Hénaut, L. (2025) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2025.1621990 · Cited by 6
Takeuchi, K., Yamauchi, Y., Shiraki, H., Sumimoto, K., Shono, A., Suzuki, M., Yamashita, K., Toba, T., Kawamori, H., Otake, H., et al. (2023) · Journal of Cardiology · doi:10.1016/j.jjcc.2023.04.008 · Cited by 4
Management of Cardiovascular Disease in the Elderly
Onuorah, I., Agrawal, A., & WENGER, N. K. (2024) · Springer eBooks · doi:10.1007/978-3-030-74720-6_25 · Cited by 4
The PREVASC study: Prospective REgistry of Valve disease in Asymptomatic Italian elderly SubjeCts
Carrabba, N., Amico, M. A., Busi, G., Vannini, M., Bruscoli, F., Fortunato, S., Arcari, L., Lorenzo, E. D., Luzi, G., Clemenza, F., et al. (2025) · Aging Clinical and Experimental Research · doi:10.1007/s40520-025-02937-5 · Cited by 4
Torigoe, M., Kitamura, M., Yamaguchi, K., Uchino, T., Torigoe, K., Harada, T., Funakoshi, S., Yamamoto, K., Maemura, K., Eishi, K., et al. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10194385 · Cited by 4
“Since AS is associated with aging [3,4], its incidence in dialysis patients is believed to increase with age [5].”
BackgroundTime trends in the epidemiology of nonrheumatic aortic valve disease in Spain, 2003-2018
Rosillo, N., Vicent, L., Sanz, D. M. D. L. M., Elola, F. J., Moreno, G., & Bueno, H. (2022) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2022.06.005 · Cited by 4
Asymptomatic severe aortic stenosis: biomarkers are welcome
Martínez‐Sellés, M., & Bayés‐Genís, A. (2018) · Heart · doi:10.1136/heartjnl-2018-314122 · Cited by 4
Zornitzki, L., Freund, O., Greenberg, I., Frydman, S., Konigstein, M., Steinvil, A., Barbash, I. M., Kornowski, R., Elbaz‐Greener, G., Dvir, D., et al. (2025) · Structural Heart · doi:10.1016/j.shj.2025.100780 · Cited by 3
Metadata
- Authors
- Danielsen, R., Aspelund, T., Harris, T. B., & Gudnason, V.
- Affiliations
- University of Iceland (IS)
- National Institutes of Health (US)
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 176
- Issue
- 3
- Pages
- 916-922
- ISSN
- 0167-5273 (ISSN-L)
- PMC
- PMC4742571
- OpenAlex
- W1992419135
- Cited by
- 168
- References
- 35
- Citations by year
- 2026: 21 · 2025: 19 · 2024: 26 · 2023: 24 · 2022: 21 · 2021: 14 · 2020: 8 · 2019: 9 · 2018: 9 · 2017: 9 · 2016: 5 · 2015: 3
- FWCI
- 3.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Hirsla (Landspítali University Hospital) (submittedVersion)
- Funders
- National Institutes of Health
- National Institute on Aging (N01-AG12100, ZIAAG007380)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- aortic stenosis, prevalence, older adults, AGES-Reykjavik Study, aortic valve calcium score, echocardiography, computed tomography, disease burden projections, Iceland
- MeSH terms
- Aged, Aged, 80 and over, Aging, Aortic Valve Stenosis, Female, Humans, Iceland, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Cohort Studies, Prevalence
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