Unveiling the Burden of Valvular Heart Disease Among Older Americans: Insights from the PREVUE-VALVE Study

Highlight

• The prevalence of moderate or greater valvular heart disease (VHD) in U.S. adults aged 65 to 85 is 8.2%, increasing to 18.4% when including mild-to-moderate regurgitant lesions.
• Tricuspid regurgitation is the most common valve lesion, followed by aortic stenosis and mitral regurgitation.
• Older age significantly increases the risk for VHD, whereas sex has no substantial effect; non-Hispanic Black individuals have a slightly lower prevalence compared to non-Hispanic Whites.
• The study demonstrates feasibility of large-scale, decentralized echocardiographic screening conducted in participants’ homes, offering a new paradigm for population cardiovascular research.

Background and Disease Burden

Valvular heart disease (VHD) constitutes a major cardiovascular condition characterized by impairment of one or more heart valves, leading to stenosis, regurgitation, or a combination thereof. Among older adults, VHD contributes significantly to morbidity and mortality through mechanisms such as heart failure, arrhythmias, and thromboembolism. With the aging U.S. population, the burden of clinically significant VHD is expected to rise steeply, imposing substantial challenges on healthcare systems in terms of diagnosis, monitoring, and treatment.

Despite its recognized impact, contemporary, population-based prevalence estimates of VHD among older Americans have been limited by regional sampling, clinical cohort biases, or reliance on administrative data lacking direct imaging confirmation. Thus, there has been a critical unmet need for robust, nationwide data capturing the true epidemiology of VHD using standardized imaging techniques.

Study Design and Methodology

The PREVUE-VALVE study was a large-scale, decentralized, observational investigation designed to determine the prevalence of VHD among individuals aged 65 to 85 years across the United States. Participants were randomly selected from pharmacy prescription records at CVS and Walgreens, ensuring broad geographic and demographic representation.

Enrolled subjects were contacted through multiple channels including e-mail, direct mail, and text messages, and consented to undergo comprehensive study procedures conducted in their homes. The centerpiece of the evaluation was a transthoracic echocardiogram (TTE) performed by trained sonographers. This approach minimized selection bias inherent in clinic-based research and leveraged a novel in-home imaging protocol.

The primary endpoint was the weighted prevalence of moderate or greater VHD, defined by echocardiographic criteria. A co-primary endpoint captured clinically significant VHD, expanding the definition to include mild-to-moderate valvular regurgitation conditions considered relevant for clinical management and prognosis.

Key Findings

The cohort included 3,000 participants representative of the U.S. older adult population (median age 71 years, 57.1% female, 14.6% non-Hispanic Black, and 9.4% Hispanic). The study yielded several important epidemiological insights:

1. Prevalence of VHD: Moderate or greater VHD was identified in 8.2% of the weighted population (95% CI: 7.0%-9.5%), while clinically significant VHD, incorporating milder lesions, affected 18.4% (95% CI: 16.7%-20.2%).

2. Valve-specific Prevalence: Tricuspid regurgitation was the most common lesion, followed by aortic stenosis, mitral regurgitation, aortic regurgitation, and mitral stenosis. These findings highlight the predominance of right-sided valve disease in older adults, an area often under-recognized clinically.

3. Age and Demographics: Increasing age was strongly associated with higher VHD prevalence. Gender did not significantly influence prevalence rates. Non-Hispanic Black participants had a modestly lower adjusted risk of any VHD compared with non-Hispanic Whites (adjusted RR: 0.91; 95% CI: 0.83-0.99), particularly due to fewer cases of aortic valve disease. There were no significant differences between Hispanic and non-Hispanic individuals.

4. Public Health Impact: Extrapolation suggested that at least 4.7 million older Americans currently have moderate or greater VHD, with estimates projecting increases to 6.5 million by 2060. For clinically significant VHD, affected individuals number approximately 10.6 million today, increasing to 14.7 million by 2060.

Expert Commentary

The PREVUE-VALVE study sets a new standard for population-based cardiovascular epidemiology through its innovative decentralized methodology and rigorous echocardiographic assessment. Its findings confirm that VHD is a common and growing health challenge among older adults in the U.S.

Importantly, the high prevalence of tricuspid regurgitation challenges prevailing clinical attention largely focused on left-sided lesions, underscoring the need for greater awareness and guideline development regarding right-sided valve pathology.

While the study’s strengths include a large representative sample and gold-standard imaging, limitations include potential participation bias inherent in voluntary studies and the constraint of a cross-sectional design precluding incidence and progression analyses. Further longitudinal follow-up and assessment of clinical outcomes from this cohort will be critical.

Current guidelines recognize the increasing prevalence of VHD with age but have lacked precise epidemiological data to support resource planning. PREVUE-VALVE provides a robust evidence base to inform future screening strategies, healthcare resource allocation, and targeted interventions.

Conclusions

PREVUE-VALVE demonstrates that valvular heart disease, particularly moderate or greater severity, affects a substantial proportion of U.S. older adults, with expected increases as the population ages. It highlights distinct patterns in valve-specific prevalence and racial demographics, providing nuanced insights into disease distribution.

The study also exemplifies the feasibility and value of decentralized, home-based echocardiographic assessment, with implications for improving access to cardiovascular diagnostics in population health initiatives.

Collectively, these findings emphasize the urgent need for enhanced screening, surveillance, and tailored therapeutic strategies to address the rising burden of valvular heart disease in the aging population.

Funding and Trial Registration

The PREVUE-VALVE study was registered under ClinicalTrials.gov identifier NCT05357404. Funding sources were not detailed in the abstract but are available in the full publication.

References

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3. Otto CM. Valvular heart disease: aortic stenosis and atrial fibrillation. Circulation. 2009;119(2):290-298.
4. Enriquez-Sarano M, Rajamannan NM, Valvular heart disease in the elderly: diagnosis and treatment. Cleveland Clinic Journal of Medicine. 2003;70(9):785-797.