Temporal Trends in Aortic Stenosis | Journal Scan

Study Questions:

What are the temporal trends for the incidence of and prognosis associated with aortic stenosis (AS) in Sweden?

Methods:

Using nationwide registers, all adult patients in the Swedish population with an initial discharge diagnosis of AS, heart failure, acute myocardial infarction, and aortic valve replacement (AVR) for AS between 1989-2009 were identified and followed until the end of 2010 for all-cause and cardiovascular-related mortality.

Results:

Between 1989-1991 and 2007-2009, the age-adjusted incidence of AS in Sweden declined from 15.0 to 11.4 per 100,000 men, and from 9.8 to 7.1 per 100,000 women; and the median age at diagnosis increased by 4 years for both men and women. Compared to 1989-1991, the age- and sex-adjusted relative risk of 1-year and 3-year mortality in 2007-2009 was 0.58 (95% confidence interval [CI], 0.53-0.63) and 0.60 (95% CI, 0.56-0.65), respectively. Similar improvements were observed for heart failure and acute myocardial infarction. Findings were broadly consistent across subgroups. Postoperative mortality at 30 days declined, despite increased median age at diagnosis.

Conclusions:

The incidence and mortality rates for AS in Sweden declined between 1989 and 2009, to an extent similar to those observed for heart failure and acute myocardial infarction. These findings could suggest that improved risk factor control and cardiovascular therapy, combined with increased utilization of AVR in the elderly and reduced perioperative mortality in AVR, have translated into favorable outcomes for AS.

Perspective:

This study provides important data in two regards to senile calcific AS. First, there appears to be a decreasing incidence of advanced AS in the Swedish population that parallels decreases in heart failure and myocardial infarction. Degenerative calcific AS is the result of an active inflammatory process, with risk factors similar to atherosclerotic cardiovascular diseases. Although trials have failed to show an ability to affect the course of relatively advanced AS with statin therapy, data from this study could suggest that longer-term lifestyle modifications (before the development of hemodynamically significant AS) still could affect the natural history of the disease. Second, despite increased age at the time of AVR, operative mortality declined over the two decades of the study, reinforcing the advances made in the surgical management of the disease.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease

Keywords: Aortic Valve Stenosis, Aortic Valve, Heart Valve Diseases, Heart Failure, Myocardial Infarction, Transcatheter Aortic Valve Replacement, Incidence, Prognosis, Risk, Risk Factors, Thoracic Surgery


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