Research Paper Volume 13, Issue 9 pp 12710—12732

Changing epidemiology of calcific aortic valve disease: 30-year trends of incidence, prevalence, and deaths across 204 countries and territories

Bin Yi1, *, , Weike Zeng2, *, , Lei Lv1, , Ping Hua1, ,

  • 1 Department of Cardiovascular Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
  • 2 Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
* Equal contribution

Received: January 19, 2021       Accepted: April 2, 2021       Published: May 11, 2021
How to Cite

Copyright: © 2021 Yi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Calcific aortic valve disease (CAVD) is associated with increased morbidity and mortality. We aimed to elucidate the 30-year epidemiology of CAVD globally. Global CAVD incidence, prevalence, and deaths increased 3.51-, 4.43-, and 1.38-fold from 1990 to 2019, respectively, without any decreasing trends, even after age standardization. In 2019, Slovenia had the highest age-standardized rate (ASR) of CAVD incidence (62.21/100,000 persons) and prevalence (1,080.06/100,000) whereas Cyprus had the highest ASR of deaths (8.20/100,000). Population aging was an important contributor to incidence. Compared with women, more men had CAVD and men had earlier peaks in disease prevalence. High systolic blood pressure, diet high in sodium, and lead exposure were the main risk factors for deaths owing to CAVD. The estimated annual percentage change, a measure to estimate the variation of ASR, was significantly associated with the ASR and sociodemographic index (SDI) in 2019 for incidence and prevalence across all 204 countries and territories (all p<0.0001). With increased lifespan and risk factors, the overall burden of CAVD is high and remains on the rise, with differences by sex, age, and SDI level. Our findings serve to sound the alarm for organizations, institutions, and resources whose primary purpose is to improve human health.


CAVD: calcific aortic valve disease; GBD: Global Burden of Disease Study; AHA/ACC: American Heart Association/American College of Cardiology; CODEm: Cause of Death Ensemble model; DisMod-MR: Disease Modeling–Meta Regression; SDI: socio-demographic index; ICD: International Statistical Classification of Diseases; ASR: age-standardized rate; ASIR: age-standardized incidence rate; ASPR: age-standardized prevalence rate; ASDR: age-standardized deaths rate; EAPC: estimated annual percentage change; CI: confidence interval; SBP: systolic blood pressure.