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Published in: BMC Cardiovascular Disorders 1/2021

Open Access 01-12-2021 | Valvular Heart Disease | Research

Current status and etiology of valvular heart disease in China: a population-based survey

Authors: Ying Yang, Zengwu Wang, Zuo Chen, Xin Wang, Linfeng Zhang, Suning Li, Congyi Zheng, Yuting Kang, Linlin Jiang, Zhenhui Zhu, Runlin Gao

Published in: BMC Cardiovascular Disorders | Issue 1/2021

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Abstract

Background

The epidemiology of valvular heart disease (VHD) has changed markedly over the last 50 years worldwide, and the prevalence and features of VHD in China are unknown. The objective of this study was to investigate the current status and etiology of VHD in China.

Methods

We used a cross-sectional national survey with stratified multistage random sampling from the general Chinese population to estimate the VHD burden. Data on demographic characteristics, medical history, physical examination, blood tests, and potential etiology were collected. Echocardiography was used to detect VHD.

Results

The national survey enrolled 34,994 people aged 35 years or older across China. Overall, 31,499 people were included in the final analysis, and 1309 participants were diagnosed with VHD. The weighted prevalence was 3.8%, with an estimated 25 million patients in China. The prevalence of VHD increased with age and was higher in participants with hypertension or chronic kidney disease than in their counterparts. Among participants with VHD, 55.1% were rheumatic and 21.3% were degenerative. The proportion of rheumatic decreased with age, and the proportion of degenerative rose with age. However, the prevalence of rheumatic disease was still higher in the elderly population than in the younger population. Logistic regression revealed that age and hypertension were correlated with VHD.

Conclusions

In China, rheumatic heart disease was still the major cause of the VHD, with a significant increase in degenerative heart disease. Age and hypertension are important and easily identifiable markers of VHD.
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Literature
1.
go back to reference Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, Forouzanfar MH, Longenecker CT, Mayosi BM, Mensah GA, Nascimento BR, Ribeiro ALP, Sable CA, Steer AC, Naghavi M, Mokdad AH, Murray CJL, Vos T, Carapetis JR, Roth GA. Global, regional, and national burden of rheumatic heart disease, 1990–2015. New Engl J Med. 2017;377(8):713–22.PubMedCrossRef Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, Forouzanfar MH, Longenecker CT, Mayosi BM, Mensah GA, Nascimento BR, Ribeiro ALP, Sable CA, Steer AC, Naghavi M, Mokdad AH, Murray CJL, Vos T, Carapetis JR, Roth GA. Global, regional, and national burden of rheumatic heart disease, 1990–2015. New Engl J Med. 2017;377(8):713–22.PubMedCrossRef
2.
go back to reference Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol. 2014;30(9):962–70.PubMedCrossRef Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol. 2014;30(9):962–70.PubMedCrossRef
3.
go back to reference Ray S. Changing epidemiology and natural history of valvular heart disease. Clin Med (Lond). 2010;10(2):168–71. Ray S. Changing epidemiology and natural history of valvular heart disease. Clin Med (Lond). 2010;10(2):168–71.
4.
go back to reference Cheng TO. How much of the recent decline in rheumatic heart disease in China can be explained by changes in cardiovascular risk factors? Int J Cardiol. 2009;132(3):300–2.PubMedCrossRef Cheng TO. How much of the recent decline in rheumatic heart disease in China can be explained by changes in cardiovascular risk factors? Int J Cardiol. 2009;132(3):300–2.PubMedCrossRef
5.
go back to reference Kodali SK, Velagapudi P, Hahn RT, Abbott D, Leon MB. Valvular heart disease in patients ≥80 years of age. J Am Coll Cardiol. 2018;71(18):2058–72.PubMedCrossRef Kodali SK, Velagapudi P, Hahn RT, Abbott D, Leon MB. Valvular heart disease in patients ≥80 years of age. J Am Coll Cardiol. 2018;71(18):2058–72.PubMedCrossRef
6.
go back to reference Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005–11.PubMedCrossRef Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005–11.PubMedCrossRef
7.
go back to reference D’Arcy JL, Coffey S, Loudon MA, Kennedy A, Pearson-Stuttard J, Birks J, Frangou E, Farmer AJ, Mant D, Wilson J, Myerson SG, Prendergast BD. Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study. Eur Heart J. 2016;37(47):3515–22.PubMedPubMedCentralCrossRef D’Arcy JL, Coffey S, Loudon MA, Kennedy A, Pearson-Stuttard J, Birks J, Frangou E, Farmer AJ, Mant D, Wilson J, Myerson SG, Prendergast BD. Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study. Eur Heart J. 2016;37(47):3515–22.PubMedPubMedCentralCrossRef
8.
go back to reference Liu FZ, Xue YM, Liao HT, Zhan XZ, Guo HM, Huang HL, Fang XH, Wei W, Rao F, Deng H, Liu Y, Lin WD, Wu SL. Five-year epidemiological survey of valvular heart disease: changes in morbidity, etiological spectrum and management in a cardiovascular center of Southern China. J Thorac Dis. 2014;6(12):1724–30.PubMedPubMedCentral Liu FZ, Xue YM, Liao HT, Zhan XZ, Guo HM, Huang HL, Fang XH, Wei W, Rao F, Deng H, Liu Y, Lin WD, Wu SL. Five-year epidemiological survey of valvular heart disease: changes in morbidity, etiological spectrum and management in a cardiovascular center of Southern China. J Thorac Dis. 2014;6(12):1724–30.PubMedPubMedCentral
9.
go back to reference Shu C, Chen S, Qin T, Fu Z, Sun T, Xie M, Zhang L, Dong N, Yin P. Prevalence and correlates of valvular heart diseases in the elderly population in Hubei. China Sci Rep. 2016;6:27253.PubMedCrossRef Shu C, Chen S, Qin T, Fu Z, Sun T, Xie M, Zhang L, Dong N, Yin P. Prevalence and correlates of valvular heart diseases in the elderly population in Hubei. China Sci Rep. 2016;6:27253.PubMedCrossRef
10.
go back to reference Wang YT, Tao J, Maimaiti A, Adi D, Yang YN, Li XM, Ma X, Liu F, Chen BD, Ma YT. Prevalence of valvular heart diseases and associated risk factors in Han, Uygur and Kazak population in Xinjiang, China. PLoS ONE. 2017;12(3):e0174490.PubMedPubMedCentralCrossRef Wang YT, Tao J, Maimaiti A, Adi D, Yang YN, Li XM, Ma X, Liu F, Chen BD, Ma YT. Prevalence of valvular heart diseases and associated risk factors in Han, Uygur and Kazak population in Xinjiang, China. PLoS ONE. 2017;12(3):e0174490.PubMedPubMedCentralCrossRef
11.
go back to reference Wang Z, Chen Z, Zhang L, Wang X, Hao G, Zhang Z, Shao L, Tian Y, Dong Y, Zheng C, Wang J, Zhu M, Weintraub WS, Gao R. Status of hypertension in China: results from the China Hypertension Survey, 2012–2015. Circulation. 2018;137(22):2344–56.CrossRef Wang Z, Chen Z, Zhang L, Wang X, Hao G, Zhang Z, Shao L, Tian Y, Dong Y, Zheng C, Wang J, Zhu M, Weintraub WS, Gao R. Status of hypertension in China: results from the China Hypertension Survey, 2012–2015. Circulation. 2018;137(22):2344–56.CrossRef
12.
go back to reference Wang Z, Chen Z, Wang X, Zhang L, Li S, Tian Y, Shao L, Hu H, Gao R. The disease burden of atrial fibrillation in China from a national cross-sectional survey. Am J Cardiol. 2018;122(5):793–8.PubMedCrossRef Wang Z, Chen Z, Wang X, Zhang L, Li S, Tian Y, Shao L, Hu H, Gao R. The disease burden of atrial fibrillation in China from a national cross-sectional survey. Am J Cardiol. 2018;122(5):793–8.PubMedCrossRef
13.
go back to reference Foundation NK. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1–266. Foundation NK. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1–266.
14.
go back to reference Lopea-Vargas PA, Tong A, Sureshkumar P, Johnson DW, Craig JC. Prevention, detection and management of early chronic kidney disease: a systematic review of clinical practice guidelines. Nephrology. 2013;18(9):592–604.CrossRef Lopea-Vargas PA, Tong A, Sureshkumar P, Johnson DW, Craig JC. Prevention, detection and management of early chronic kidney disease: a systematic review of clinical practice guidelines. Nephrology. 2013;18(9):592–604.CrossRef
15.
go back to reference Baumgartner H, Hung J, Bermejo J, Chambers JB, Edvardsen T, Goldstein S, Lancellotti P, LeFevre M, Miller FJ, Otto CM. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2017;30(4):372–92.PubMedCrossRef Baumgartner H, Hung J, Bermejo J, Chambers JB, Edvardsen T, Goldstein S, Lancellotti P, LeFevre M, Miller FJ, Otto CM. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2017;30(4):372–92.PubMedCrossRef
16.
go back to reference Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, Hahn RT, Han Y, Hung J, Lang RM, Little SH, Shah DJ, Shernan S, Thavendiranathan P, Thomas JD, Weissman NJ. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr. 2017;30(4):303–71.PubMedCrossRef Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, Hahn RT, Han Y, Hung J, Lang RM, Little SH, Shah DJ, Shernan S, Thavendiranathan P, Thomas JD, Weissman NJ. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr. 2017;30(4):303–71.PubMedCrossRef
17.
go back to reference Iung B, Vahanian A. Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol. 2011;8(3):162–72.PubMedCrossRef Iung B, Vahanian A. Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol. 2011;8(3):162–72.PubMedCrossRef
18.
go back to reference Reményi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, Lawrenson J, Maguire G, Marijon E, Mirabel M, Mocumbi AO, Mota C, Paar J, Saxena A, Scheel J, Stirling J, Viali S, Balekundri VI, Wheaton G, Zühlke L, Carapetis J. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease–an evidence-based guideline. Nat Rev Cardiol. 2012;9(5):297–309.PubMedPubMedCentralCrossRef Reményi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, Lawrenson J, Maguire G, Marijon E, Mirabel M, Mocumbi AO, Mota C, Paar J, Saxena A, Scheel J, Stirling J, Viali S, Balekundri VI, Wheaton G, Zühlke L, Carapetis J. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease–an evidence-based guideline. Nat Rev Cardiol. 2012;9(5):297–309.PubMedPubMedCentralCrossRef
20.
go back to reference Hu P, Liu X, Liang J, Zhu Q, Pu C, Tang M, Wang J. A hospital-based survey of patients with severe valvular heart disease in China. Int J Cardiol. 2017;231:244–7.PubMedCrossRef Hu P, Liu X, Liang J, Zhu Q, Pu C, Tang M, Wang J. A hospital-based survey of patients with severe valvular heart disease in China. Int J Cardiol. 2017;231:244–7.PubMedCrossRef
21.
go back to reference Iung B, Delgado V, Rosenhek R, Price S, Prendergast B, Wendler O, De Bonis M, Tribouilloy C, Evangelista A, Bogachev-Prokophiev A, Apor A, Ince H, Laroche C, Popescu BA, Piérard L, Haude M, Hindricks G, Ruschitzka F, Windecker S, Bax JJ, Maggioni A, Vahanian A, EORP VHD II Investigators. Contemporary presentation and management of valvular heart disease: The EURObservational research programme valvular heart disease II survey. Circulation. 2019;140(14):1156–69.PubMedCrossRef Iung B, Delgado V, Rosenhek R, Price S, Prendergast B, Wendler O, De Bonis M, Tribouilloy C, Evangelista A, Bogachev-Prokophiev A, Apor A, Ince H, Laroche C, Popescu BA, Piérard L, Haude M, Hindricks G, Ruschitzka F, Windecker S, Bax JJ, Maggioni A, Vahanian A, EORP VHD II Investigators. Contemporary presentation and management of valvular heart disease: The EURObservational research programme valvular heart disease II survey. Circulation. 2019;140(14):1156–69.PubMedCrossRef
22.
go back to reference Xinghe H, Jing L, Xueke B. A hospital-based retrospective study of patients with valvular heart diseases in China (the China Peace retrospective study of valvular heart disease). JACC. 2019;73(9):1965.CrossRef Xinghe H, Jing L, Xueke B. A hospital-based retrospective study of patients with valvular heart diseases in China (the China Peace retrospective study of valvular heart disease). JACC. 2019;73(9):1965.CrossRef
23.
go back to reference Rwebembera J, Manyilirah W, Zhu ZW, Nabbaale J, Namuyonga J, Ssinabulya I, Lubega S, Lwabi P, Omagino J, Okello E. Prevalence and characteristics of primary left-sided valve disease in a cohort of 15,000 patients undergoing echocardiography studies in a tertiary hospital in Uganda. BMC Cardiovasc Disord. 2018;18(1):82.PubMedPubMedCentralCrossRef Rwebembera J, Manyilirah W, Zhu ZW, Nabbaale J, Namuyonga J, Ssinabulya I, Lubega S, Lwabi P, Omagino J, Okello E. Prevalence and characteristics of primary left-sided valve disease in a cohort of 15,000 patients undergoing echocardiography studies in a tertiary hospital in Uganda. BMC Cardiovasc Disord. 2018;18(1):82.PubMedPubMedCentralCrossRef
24.
go back to reference Triki F, Jdidi J, Abid D, Tabbabi N, Charfeddine S, Ben Kahla S, Hentati M, Abid L, Kammoun S. Characteristics, aetiological spectrum and management of valvular heart disease in a Tunisian cardiovascular centre. Arch Cardiovasc Dis. 2017;110(8–9):439–46.PubMedCrossRef Triki F, Jdidi J, Abid D, Tabbabi N, Charfeddine S, Ben Kahla S, Hentati M, Abid L, Kammoun S. Characteristics, aetiological spectrum and management of valvular heart disease in a Tunisian cardiovascular centre. Arch Cardiovasc Dis. 2017;110(8–9):439–46.PubMedCrossRef
25.
go back to reference Yu Q, Wang B, Wang Y, Dai CL. Level and trend of cardiovascular disease mortality in China from 2002 to 2016. Zhonghua Xin Xue Guan Bing Za Zhi. 2019;47(6):479–85 (Chinese).PubMed Yu Q, Wang B, Wang Y, Dai CL. Level and trend of cardiovascular disease mortality in China from 2002 to 2016. Zhonghua Xin Xue Guan Bing Za Zhi. 2019;47(6):479–85 (Chinese).PubMed
26.
go back to reference Chen HZ, Fan WH, Jin XJ, Wang Q, Zhou J, Shi ZY. Changing trends of etiologic characteristics of cardiovascular diseases among inpatients in Shanghai: a retrospective observational study from 1948 to 1999. Zhonghua Nei Ke Za Zhi. 2003;42(12):829–32 (Chinese).PubMed Chen HZ, Fan WH, Jin XJ, Wang Q, Zhou J, Shi ZY. Changing trends of etiologic characteristics of cardiovascular diseases among inpatients in Shanghai: a retrospective observational study from 1948 to 1999. Zhonghua Nei Ke Za Zhi. 2003;42(12):829–32 (Chinese).PubMed
27.
go back to reference Iung B, Baron G, Tornos P, Gohlke-Bärwolf C, Butchart EG, Vahanian A. Valvular heart disease in the community: a European experience. Curr Probl Cardiol. 2007;32(11):609–61.PubMedCrossRef Iung B, Baron G, Tornos P, Gohlke-Bärwolf C, Butchart EG, Vahanian A. Valvular heart disease in the community: a European experience. Curr Probl Cardiol. 2007;32(11):609–61.PubMedCrossRef
28.
go back to reference Andell P, Li X, Martinsson A, Andersson C, Stagmo M, Zöller B, Sundquist K, Smith JG. Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study. Heart. 2017;103(21):1696–703.PubMedCrossRef Andell P, Li X, Martinsson A, Andersson C, Stagmo M, Zöller B, Sundquist K, Smith JG. Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study. Heart. 2017;103(21):1696–703.PubMedCrossRef
29.
go back to reference Yunqing Y, Haiyan X, Zhe L, Qingrong L, Xiling Q, Jie H, Yongjian W. Distribution and etiology of valvular heart disease in the elderly in different regions of China. Chin J Geriatr Heart Brain Vessel Dis. 2019;21(7):676–82. Yunqing Y, Haiyan X, Zhe L, Qingrong L, Xiling Q, Jie H, Yongjian W. Distribution and etiology of valvular heart disease in the elderly in different regions of China. Chin J Geriatr Heart Brain Vessel Dis. 2019;21(7):676–82.
31.
go back to reference Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol. 1999;83(6):897–902.PubMedCrossRef Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol. 1999;83(6):897–902.PubMedCrossRef
32.
go back to reference Baumgartner RN, Heymsfield SB, Roche AF. Human body composition and the epidemiology of chronic disease. Obes Res. 1995;3(1):73–95.PubMedCrossRef Baumgartner RN, Heymsfield SB, Roche AF. Human body composition and the epidemiology of chronic disease. Obes Res. 1995;3(1):73–95.PubMedCrossRef
33.
go back to reference De Schutter A, Lavie CJ, Milani RV. The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox. Prog Cardiovasc Dis. 2014;56(4):401–8.PubMedCrossRef De Schutter A, Lavie CJ, Milani RV. The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox. Prog Cardiovasc Dis. 2014;56(4):401–8.PubMedCrossRef
34.
go back to reference Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O’Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS, American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56–528.PubMedCrossRef Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O’Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS, American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56–528.PubMedCrossRef
35.
go back to reference Arden C, Chambers JB, Sandoe J, Ray S, Prendergast B, Taggart D, Westaby S, Grothier L, Wilson J, Campbell B, Gohlke-Bärwolf C, Mestres CA, Rosenhek R, Pibarot P, Otto CM. Can we improve the detection of heart valve disease? Heart. 2014;100(4):271–3.PubMedCrossRef Arden C, Chambers JB, Sandoe J, Ray S, Prendergast B, Taggart D, Westaby S, Grothier L, Wilson J, Campbell B, Gohlke-Bärwolf C, Mestres CA, Rosenhek R, Pibarot P, Otto CM. Can we improve the detection of heart valve disease? Heart. 2014;100(4):271–3.PubMedCrossRef
36.
go back to reference Celermajer DS, Chow CK, Marijon E, Anstey NM, Woo KS. Cardiovascular Disease in the Developing World: prevalences, patterns, and the potential of early disease detection. JACC. 2012;60(14):1207–16.PubMedCrossRef Celermajer DS, Chow CK, Marijon E, Anstey NM, Woo KS. Cardiovascular Disease in the Developing World: prevalences, patterns, and the potential of early disease detection. JACC. 2012;60(14):1207–16.PubMedCrossRef
Metadata
Title
Current status and etiology of valvular heart disease in China: a population-based survey
Authors
Ying Yang
Zengwu Wang
Zuo Chen
Xin Wang
Linfeng Zhang
Suning Li
Congyi Zheng
Yuting Kang
Linlin Jiang
Zhenhui Zhu
Runlin Gao
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2021
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-021-02154-8

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