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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.”
From Calcific aortic stenosis (2016) · cites this paper as [15]
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Citations
Cites
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“Several epidemiological studies and surveys clearly indicate that many elderly patients with symptomatic significant AS are not even evaluated for AVI by their attending general practitioner or cardiologist [1, 5, 8].”
BackgroundThe Role of Stress Echocardiography in Valvular Heart Disease: A Current Appraisal
Gentry, J. L., Phelan, D. M. J., Desai, M. Y., & Griffin, B. P. (2017) · Cardiology · doi:10.1159/000460274 · Cited by 2,739
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Rossebø, A. B., Pedersen, T. R., Boman, K., Brudi, P., Chambers, J. B., Egstrup, K., Gerdts, E., Gohlke-Bärwolf, C., Holme, I., Kesäniemi, Y. A., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0804602 · Cited by 1,644 · cited 1×
“The randomized, placebo controlled SEAS study, were simvastatin was used in patients with AS, however, demonstrated no effect [32].”
MethodAortic Stenosis in the Elderly
Osnabrugge, R. L. J., Mylotte, D., Head, S. J., Van Mieghem, N. M., Nkomo, V. T., LeReun, C. M., Bogers, A. J. J. C., Piazza, N., & Kappetein, A. P. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.05.015 · Cited by 1,378 · cited 18×
“Several epidemiological studies and surveys clearly indicate that many elderly patients with symptomatic significant AS are not even evaluated for AVI by their attending general practitioner or cardiologist [1, 5, 8].”
BackgroundMethodInfluentialLindroos, M., Kupari, M. M., Heikkilä, J., & Tilvis, R. S. (1993) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(93)90249-z · Cited by 1,148
Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?
Iung, B., Cachier, A., Baron, G., Messika-Zeitoun, D., Delahaye, F., Tornos, P., Gohlke-Bärwolf, C., Boersma, E., Ravaud, P., & Vahanian, A. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi471 · Cited by 1,108 · cited 13×
“Several epidemiological studies and surveys clearly indicate that many elderly patients with symptomatic significant AS are not even evaluated for AVI by their attending general practitioner or cardiologist [1, 5, 8].”
BackgroundInfluentialGenetic Associations with Valvular Calcification and Aortic Stenosis
Thanassoulis, G., Campbell, C. Y., Owens, D. S., Smith, J. G., Smith, A. V., Peloso, G. M., Kerr, K. F., Pechlivanis, S., Budoff, M. J., Harris, T. B., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1109034 · Cited by 1,008 · cited 1×
“Furthermore, genetic factors are known to predispose to the development of AS [31].”
BackgroundSelf-citationFreeman, R. V., & Otto, C. M. (2005) · Circulation · doi:10.1161/circulationaha.104.486738 · Cited by 1,006 · cited 3×
“Currently there is no known medical treatment to halt or prevent the devolvement of aortic valve calcification that may evolve into significant AS [27].”
BackgroundNilssen, O., Førde, O. H., & Brenn, T. (1990) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115661 · Cited by 813
The evolving epidemiology of valvular aortic stenosis. The Tromsø Study
Eveborn, G. W., Schirmer, H., Heggelund, G., Lunde, P., & Rasmussen, K. (2012) · Heart · doi:10.1136/heartjnl-2012-302265 · Cited by 660 · cited 1×
“Many previous echocardiography studies have used different measures to detect AS; the velocity across the valve, maximum or mean gradients and calculations of the aortic valve area, most often by the continuity equation [2, 3, 5].”
MethodAge, Gene/Environment Susceptibility-Reykjavik Study: multidisciplinary applied phenomics
Harris, T. B., Launer, L. J., Eiriksdottir, G., Kjartansson, O., Jonsson, P. V., Sigurdsson, G., Thorgeirsson, G., Aspelund, T., Garcia, M. E., Cotch, M. F., et al. (2007) · American Journal of Epidemiology · doi:10.1093/aje/kwk115 · Cited by 592 · cited 5×
“Overall, the participation rate in the study was 72% for men and 80% for women [13].”
BackgroundMethodInfluentialSelf-citationNatural History of Very Severe Aortic Stenosis
Rosenhek, R., Zilberszac, R., SCHEMPER, M., Czerny, M., Mundigler, G., Graf, S., Bergler-Klein, J. K., Grimm, M. F., Gabriel, H., & Maurer, G. (2009) · Circulation · doi:10.1161/circulationaha.109.894170 · Cited by 524 · cited 1×
“Many, however, will be too ill and frail for either procedure and will need demanding treatment for heart failure, atrial fibrillation and coronary artery disease [8–10].”
BackgroundCueff, C., Serfaty, J.-M., Cimadevilla, C., Laissy, J.-P., Himbert, D., Tubach, F., Duval, X., Iung, B., Enriquez-Sarano, M., Vahanian, A., et al. (2011) · Heart · doi:10.1136/hrt.2010.198853 · Cited by 385 · cited 2×
“Because the current study population is randomly selected and has a wide spectrum of aortic valve sclerosis and stenosis, a relatively low AVCS was found to indicate significant AS in comparison to some previous studies [21, 22].”
BackgroundResultKatz, R., Wong, N. D., Kronmal, R. A., Takasu, J., Shavelle, D. M., Probstfield, J. L., Bertoni, A. G., Budoff, M. J., & O’Brien, K. D. (2006) · Circulation · doi:10.1161/circulationaha.105.598086 · Cited by 282 · cited 1×
“In addition, similar clinical factors are associated with aortic valve sclerosis and atherosclerosis and include older age, hyperlipidemia, smoking, male gender, hypertension and diabetes [26, 29].”
BackgroundTrends in the incidence and prevalence of atrial fibrillation in Iceland and future projections
Stefansdottir, H., Aspelund, T., Gudnason, V. G., & Arnar, D. O. (2011) · EP Europace · doi:10.1093/europace/eur132 · Cited by 187 · cited 1×
“Many, however, will be too ill and frail for either procedure and will need demanding treatment for heart failure, atrial fibrillation and coronary artery disease [8–10].”
BackgroundSelf-citationWenaweser, P., Stortecky, S., Schwander, S., Heg, D., Huber, C. H., Pilgrim, T., Gloekler, S., O'Sullivan, C. J., Meier, B., Jüni, P., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht086 · Cited by 153 · cited 1×
“There is, however, already a trend to lower the threshold for TAVI to patients with low and intermediate surgical risk [25].”
BackgroundAortic Valve Calcification as a Marker for Aortic Stenosis Severity: Assessment on 16-MDCT
Koos, R., Mahnken, A. H., Sinha, A. M., Wildberger, J. E., Hoffmann, R., & Kühl, H. P. (2004) · American Journal of Roentgenology · doi:10.2214/ajr.183.6.01831813 · Cited by 142 · cited 1×
“Because the current study population is randomly selected and has a wide spectrum of aortic valve sclerosis and stenosis, a relatively low AVCS was found to indicate significant AS in comparison to some previous studies [21, 22].”
ResultPrognostic Value of Energy Loss Index in Asymptomatic Aortic Stenosis
Bahlmann, E., Gerdts, E., Cramariuc, D., Gohlke-Baerwolf, C., Nienaber, C. A., Wachtell, K., Seifert, R., Chambers, J. B., Kück, K., & Ray, S. G. (2013) · Circulation · doi:10.1161/circulationaha.112.078857 · Cited by 135 · cited 3×
“It also has to be kept in mind that assessment of the AVA from the Gorlin formula by heart catheterization, previously used as the gold standard for echo and Doppler studies, also has several pitfalls [18, 19].”
BackgroundMethodO'Sullivan, C. J., Stortecky, S., Heg, D., Pilgrim, T., Hošek, N., Buellesfeld, L., Khattab, A. A., Nietlispach, F., Moschovitis, A., Zanchin, T., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht408 · Cited by 113
Koos, R., Kühl, H. P., Mühlenbruch, G., Wildberger, J. E., Günther, R. W., & Mahnken, A. H. (2006) · Radiology · doi:10.1148/radiol.2411051163 · Cited by 90
Muraru, D., Badano, L. P., Vannan, M. A., & Iliceto, S. (2012) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jes075 · Cited by 67 · cited 1×
“Errors in measuring the diameter of the left ventricular outflow tract are well known and it has been suggested that using threedimensional echo can give a better assessment of the area of the left ventricular outflow tract used in the continuity equation [20].”
MethodBerry, C., Lloyd, S. M., Wang, Y., MacDonald, A., & Ford, I. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs339 · Cited by 64 · cited 2×
“The prevalence of AS increases with age and, in line with the rapidly increasing elderly population in the industrialized countries, the number of patients diagnosed with AS will increase considerably [3, 5].”
BackgroundMethodFactors affecting doppler echocardiographic valve area assessment in aortic stenosis
Daníelsen, R., Nordrehaug, J. E., & Vik‐Mo, H. (1989) · The American Journal of Cardiology · doi:10.1016/0002-9149(89)90087-8 · Cited by 61 · cited 2×
“It also has to be kept in mind that assessment of the AVA from the Gorlin formula by heart catheterization, previously used as the gold standard for echo and Doppler studies, also has several pitfalls [18, 19].”
BackgroundMethodHekimian, G., Boutten, A., Flamant, M., Duval, X., Dehoux, M., Benessiano, J., Huart, V., Dupré, T., Berjeb, N., Tubach, F., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/ehs450 · Cited by 53 · cited 1×
“Vitamin D status, bone remodeling and secondary hyperparathyroidism has also been implicated in AS progression [30].”
BackgroundSverdlov, A. L., Ngo, D. T. M., Chan, W. P. A., Chirkov, Y. Y., Gersh, B. J., McNeil, J. J., & Horowitz, J. D. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs171 · Cited by 36 · cited 1×
“There are also some indications that the renin-angiotensin system and endothelial dysfunction may also be involved in the calcification process of the aortic valve [27, 28].”
BackgroundLimitations in assessing the severity of aortic stenosis by Doppler gradients.
Daníelsen, R., Nordrehaug, J. E., Stangeland, L. B., & Vik‐Mo, H. (1988) · Heart · doi:10.1136/hrt.59.5.551 · Cited by 34 · cited 1×
“A low gradient can be found in patients with impaired left ventricular function and also in those with paradoxical low flow low gradients in spite of a normal ejection fraction [7, 16].”
BackgroundCoronary artery calcium distributions in older persons in the AGES-Reykjavik study
Gudmundsson, E. F., Gudnason, V. G., Sigurdsson, S. O., Launer, L. J., Harris, T. B., & Aspelund, T. (2012) · European Journal of Epidemiology · doi:10.1007/s10654-012-9730-6 · Cited by 31
Self-citationClinical and haemodynamic features in relation to severity of aortic stenosis in adults
Daníelsen, R., Nordrehaug, J. E., & Vik‐Mo, H. (1991) · European Heart Journal · doi:10.1093/eurheartj/12.7.791 · Cited by 17 · cited 1×
“Clinical symptoms in the elderly with AS are often not specific and do not always correlate well with the severity of AS [24].”
BackgroundPatient selection for transcatheter aortic valve replacement: what does the future hold?
Osnabrugge, R. L. J., Head, S. J., Bogers, A. J. J. C., & Kappetein, A. P. (2012) · Expert Review of Cardiovascular Therapy · doi:10.1586/erc.12.54 · Cited by 8 · cited 15×
“By combining these data an evaluation was done to assess the number of patients likely to have severe AS in the future, potentially needing open AVI or TAVI.”
BackgroundInfluentialImproving Outlook for Elderly Patients With Aortic Stenosis
Bonow, R. O. (2013) · JAMA · doi:10.1001/jama.2013.281825 · Cited by 7 · cited 1×
“Although nomedical treatment is currently effective in slowing down the development of AS, the outlook for elderly patients that undergo AVI, either by surgery or TAVI, has fortunately greatly improved [33].”
Background
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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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