Aortic insufficiency epidemiology and demographics


 * Associate Editor-In-Chief: Varun Kumar, M.B.B.S., Lakshmi Gopalakrishnan, M.B.B.S., Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org]

Overview
The prevalence of aortic regurgitation varies with age, geographic location, and gender. Aortic insufficiency is unusual before the age of 50 and then increases progressively later in life. Worldwide the most common cause of aortic insufficiency is rheumatic heart disease, particularly in Asia, the Middle East, and North Africa. In the United States, senile degenerative calcific aortic valve disease and bicuspid aortic valve disease are the most common causes.

Prevalence
The prevalence of aortic insufficiency increases with age and is more common in men than in women.

In the Framingham Heart population cohort study, aortic regurgitation (more than or equal to trace severity on echocardiography) was observed in 13 percent of men and 8.5 percent of women. AR is infrequent in young patients, and occurs in < 1% of subjects under the age of 70.

Developing Countries
In developing countries, rheumatic heart disease is the most common cause of aortic insufficiency and may present in second or third decade of life.

Developed Countries
In developed countries where rheumatic heart disease is rare, aortic insufficiency may be due to bicuspid aortic valve disease or senile calcific degenerative aortic valve disease which may present in the fourth to sixth decade. Endocarditis and aortic dissection are other causes. The prevalence of any aortic insufficiency in the Framingham study was reported to be 4.9%, with regurgitation of moderate or greater severity occurring in 0.5%.

Race
The prevalence of aortic insufficiency does not show any variation by race in United States. However, internationally there is significant variation in the prevalence of predisposing conditions such as rheumatic heart disease which is more common in Asia, the Middle East and North Africa.

Gender
The prevalence of aortic insufficiency is higher in men than in women. Aortic insufficiency was found in 13% of men versus 8.5% of women in Framingham study. The higher prevalence of marfan syndrome and bicuspid aortic valve in males could explain in part the greater prevalence of aortic insufficiency in men.

Age
The prevalence and severity of AR increases with age, with a higher prevalence of chronic severe aortic insufficiency among patients over 70 years of age. In general, AR is infrequent in young patients, and occurs in < 1% of subjects under the age of 70. However people with congenital aortic valve/root defects such as bicuspid aortic valve disease and Marfan syndrome may develop aortic insufficiency much earlier in life.