28% of “healthy” older adults have undiagnosed heart valve disease

One study identified undiagnosed heart valve disease in 28% of people over 60, highlighting the importance of better screening in managing the health of older adults.

• Nearly 4,500 healthy people over the age of 60 without symptoms were examined, 28% of whom suffered from heart valve disease.
• Age has been shown to be strongly associated with an increased incidence of significant heart valve disease.
• Study lays the foundation for additional research into the potential role of screening in the elderly population

The extent of undiagnosed heart valve disease in our aging population has been revealed for the first time, thanks to new research led by the University of East Anglia.

More than a quarter of healthy, symptom-free people over 60 examined in the study had previously undetected heart valve disease.

Co-senior author Vassilios Vassiliou, clinical professor of cardiac medicine at UEA’s Norwich Medical School, said: “This study focused on understanding the extent of heart valve problems, regardless of or their severity, among healthy adults, without symptoms and without any known heart disease.

Key findings on the prevalence of heart valve disease

“We examined almost 4,500 people aged 60 and over from three areas of the UK: Norfolk, West Midlands and Aberdeen, using echocardiography, which is an ultrasound scan of the heart.

“Our results showed that more than 28% of these adults had some form of heart valve disease, although reassuringly it was only mild in the majority of cases.

“The data also indicated that age was the main factor associated with these heart valve problems, meaning the older a person is, the higher their risk of having a significant valve problem.”

Understanding the functions and problems of heart valves

Blood flows through the heart and the rest of the body in only one direction, like a one-way circulation system.

The four heart valves (pulmonary and tricuspid on the right side, and aortic and mitral on the left side of the heart) control the direction of blood flow ensuring optimal pumping of the heart.

Co-lead author Professor Michael Frenneaux, from the Royal Brompton Hospital, part of Guy’s and St Thomas’ NHS Foundation Trust and Imperial College Londonsaid: “Heart valve disease occurs when one or more heart valves do not function as they should.

“The main problems are caused by a valve that does not open fully (valvular stenosis), which restricts blood flow, or by a valve that does not close properly (valvular regurgitation), which means that blood can flow back in the wrong direction.

“These problems can put extra strain on the heart and make it work harder. Over time, this can increase the risk of heart attack, stroke and other heart diseases.

Challenges in diagnosing heart valve disease

Symptoms may include feeling short of breath, chest pain, feeling weak or dizzy, swollen ankles and feet, feeling more tired than usual, and palpitations in the chest or neck.

Between 2007 and 2016, a total of 10,000 asymptomatic patients, aged over 60, were invited through their GP practice to take part in the study funded by the British Heart Foundation.

Of these, 5,429 volunteered to participate, of whom 4,237 were eligible for inclusion.

They were evaluated with a health questionnaire, a clinical examination and a transthoracic echocardiogram, which is an ultrasound of the heart.

Valvulopathy was diagnosed in 28.2% of patients. The prevalence of clinically significant heart valve disease was only 2.4%, with a moderate or severe case being diagnosed in one in 42 people over the age of 60, and in one in 15 among those aged 75 and over.

However, only 21% – 900 of the 4,237 patients evaluated – were 75 years or older and only 8.6% were over 80 years old.

Professor Vassiliou said: “The diagnosis of heart valve disease is primarily based on transthoracic echocardiography, however, this is normally only carried out if symptoms are reported or an unusual murmur is heard during a physical examination.

“This can be difficult in older people, as mild symptoms may be masked by reduced physical activity and reduced mobility. »

Potential for improvement in screening and care

“This study finds that many older adults have heart valve problems even if they have no symptoms and we suggest that if people develop new symptoms or signs that may indicate heart disease, they discuss them with their doctor », continues Professor Vassiliou.

“As our population ages, this information can help healthcare providers understand the magnitude of heart valve disease and streamline routine care methods and screening programs to ensure we can meet demand in the future.

“This way, they can better identify and help people at risk before problems get worse.” »

Researchers say additional studies are needed to clarify the prevalence of the disease in the elderly population and how screening could be used to help identify and manage the disease.

James Leiper, associate medical director at the British Heart Foundation, said: “This important research involving a very large group of people without symptoms showed that more than a quarter of participants had previously undetected heart valve disease.

“Further research will be needed to build on this strong foundation and develop methods to test the feasibility of identifying disease in these individuals.”

“Although we have made progress, there is still much to be done to eradicate heart disease for good. It is essential that we continue to fund life-saving research, so that fewer people experience heartbreak.

Reference: “Prevalence of asymptomatic valvulopathies in the elderly population: a community echocardiographic study” June 26, 2024, European Heart Journal – Cardiovascular Imaging.
DOI: 10.1093/ehjci/jeae127

The research also involved Norfolk and Norwich University Hospital, Aberdeen Royal Infirmary, University of Aberdeen, University of Birminghamthe Royal Brompton Hospital in London and Imperial College London.