Untreated Aortic Stenosis Affecting Baby Boomer Generation at Alarming Rates

THE AGING POPULATION: “Baby Boomers” and Aortic Stenosis

Untreated Aortic Stenosis Affecting Baby Boomer Generation at Alarming Rates

Photo Credit: HeartBabyHome via Compfight cc

Aortic stenosis (AS) is the most common heart valve problem in the United States, affecting an estimated 3.4 million people in the United States.  As with many cardiovascular syndromes, the prevalence of aortic stenosis increases with age and it has been estimated that approximately 2% of people over the age of 65, 3% of people over age 75, and 4% percent of people over age 85 have clinically significant aortic valve stenosis.  The first wave of “Baby Boomers” has now reached 65 years of age and the prevalence of aortic stenosis is on the rise.  A recent report by the L.E.K. Consulting estimated that there are 320,000 people over age 65 in the United States who meet indication for aortic valve replacement.[1]  Yet and still, only about 20% of these patients ever receive appropriate surgical therapy.

WHAT TO LOOK OUT FOR: Heart Murmurs? Weak and dizzy spells?

The classic signs and symptoms of aortic stenosis are chest pain, shortness of breath and fainting spells.  While these are relatively non-specific signs and symptoms, if you have any of them (especially if they are related to exercise or exertion) you should report to your physician as soon as possible for examination.  These signs and symptoms become particularly ominous if you have ever been told you have a heart murmur as this is the most common indication of significant aortic stenosis.

Many times, however, the signs and symptoms are more subtle; perhaps a progressively declining capacity for work or activities of daily living, increasing requirement for rest during the day, or frequent weak and dizzy spells.

WHAT YOU CAN DO ABOUT IT: Importance of Stress Testing

Surprisingly, a significant number of patients develop progressive, lifestyle limiting, aortic stenosis and never receive appropriate evaluation because when they present to their physician’s offices they are asymptomatic.  Indeed, in a recent study in the Journal of the American College of Cardiology, the most common reason patients with aortic stenosis are NOT sent for surgical therapy, is because they are PRESUMED to be without symptoms![2]  One of the most important things you can do is to inform your physician if your symptoms are worse with EXERTION so that he or she may order the appropriate stress testing to evaluate your aortic valve.

SURGICAL TREATMENT: Early Intervention Increases Longevity

Treadmill, Stress Testing and Aortic Stenosis Among Baby Boomer GenerationRecent studies from the Cleveland Clinic and other centers have shown that early intervention in the form of aortic valve replacement is advantageous even in patient with severe aortic stenosis who are asymptomatic.[3]  Patients who receive aortic valve replacement for severe aortic stenosis before their hearts show signs of dysfunction can have a life expectancy equivalent to unaffected age matched patients, with much lower risk of complication or death than those patients who do exhibit ventricular dysfunction prior to surgery.

MINIMALLY INVASIVE AND PERCUTANEOUS (CATHETER) TECHNIQUES

Specially trained cardiothoracic surgeons can now perform aortic valve replacement through very small incisions (2-3 inches) and will soon be able to replace the aortic valve using percutaneous techniques.  New transcatheter technology which has just received FDA approval will allow physicians to replace heart valves through very small incisions in the leg without having to open the chest.

“This technology has the potential to change the paradigm for treating aortic stenosis.  Almost all patients with isolated aortic stenosis are candidates for minimally invasive approaches and this strategy has become the standard of care in many communities.”

— V. Antoine Keller, Cardiovascular and Thoracic Surgeon, Cardiovascular and Thoracic Specialists


[1] LEK, Project Helium Analysis, November 10, 2005

[2] Bach DS, et al. J. Am. Coll. Cardiol. 2007;50;2018-2019

[3] Mihaljevic T, et al J Thorac Cardiovasc Surg 2008;135:1270-9

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