Aortic regurgitation epidemiology and demographics: Difference between revisions

	Aortic Regurgitation Microchapters
Home
Patient Information
Overview
Historical Pesrpective
Pathophysiology
Causes
Stages
Differentiating Aortic Regurgitation from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Cardiac Stress Test
Electrocardiogram
Chest X Ray
Echocardiography
Cardiac MRI
Treatment
Acute Aortic regurgitation Medical Therapy Surgery
Chronic Aortic regurgitation Medical Therapy Surgery
Precautions and Prophylaxis
Special Scenarios Pregnancy Elderly Young Adults End-stage Renal Disease
Case Studies
Case #1
Aortic regurgitation epidemiology and demographics On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Aortic regurgitation epidemiology and demographics All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Aortic regurgitation epidemiology and demographics
CDC on Aortic regurgitation epidemiology and demographics
Aortic regurgitation epidemiology and demographics in the news
Blogs on Aortic regurgitation epidemiology and demographics
Directions to Hospitals Treating Aortic regurgitation
Risk calculators and risk factors for Aortic regurgitation epidemiology and demographics

VisualWikitext

Latest revision as of 12:56, 30 January 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Mohammed A. Sbeih, M.D. [2]; Usama Talib, BSc, MD [3]

Overview

The prevalence of aortic regurgitation varies with age, geographic location, and gender.^[1] aortic regurgitation is unusual before the age of 50 and then increases progressively later in life. Worldwide the most common cause of aortic regurgitation is the rheumatic heart disease, particularly in the Asia, the Middle East, and the North Africa. In the United States, senile degenerative calcific aortic valve disease and bicuspid aortic valve disease are the most common causes.^[2]

Epidemiology and Demographics

Prevalence

The Framingham Heart Study, a prospective epidemiological study, evaluated the prevalence and severity of aortic regurgitation and other valvular diseases by color Doppler examinations in 1,696 men and 1,893 women. The study revealed that the prevalence of aortic regurgitation (ranging in severity from trace to ≥ moderate regurgitation) is 13.0% in men and 8.5% in women.^[1] ^[3]

Age

The prevalence of aortic regurgitation increases with age.^[1]^[4]^[5] It 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 regurgitation much earlier in life.^[6]^[7]

Shown below are tables depicting the prevalence of AR by age and severity in men and women according the results of the Framingham Heart Study.^[1]

Severity of AR	Prevalence of AR by age in men
	26-29	40-49	50-59	60-69	70-83
No AR (%)	96.7	95.4	91.1	74.3	75.6
Trace (%)	3.3	2.9	4.7	13	10
Mild (%)	0	1.4	3.7	12.1	12.2
Moderate or severe (%)	0	0.3	0.5	0.6	2.2

Severity of AR	Prevalence of AR by age in women
	26-29	40-49	50-59	60-69	70-83
No AR (%)	98.9	96.6	92.4	86.9	73
Trace (%)	1.1	2.7	5.5	6.3	10.1
Mild (%)	0	0.7	1.9	6	14.6
Moderate or severe (%)	0	0	0.2	0.8	2.3

Gender

aortic regurgitation is more common in men than in women.^[1]^[4]^[5] 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.^[1] The higher prevalence of marfan syndrome and bicuspid aortic valve in males could explain in part the greater prevalence of aortic regurgitation in men.^[6]^[7]

Race

The prevalence of aortic regurgitation 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 the Asia, the Middle East, and the North Africa.^[8]

Developed Countries

In developed countries where rheumatic heart disease is rare, aortic regurgitation may be due to bicuspid aortic valve disease or senile degenerative calcific aortic valve disease which may present in the fourth to sixth decade. Endocarditis and aortic dissection are other causes. The prevalence of any aortic regurgitation in the Framingham study was reported to be 4.9%, with regurgitation of moderate or greater severity occurring in 0.5%.^[1]

Developing Countries

In developing countries, rheumatic heart disease is the most common cause of aortic regurgitation and may present in second or third decade of life.^[9]

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ (1999). "Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study)". The American Journal of Cardiology. 83 (6): 897–902. PMID 10190406. Retrieved 2011-12-27. Unknown parameter |month= ignored (help)
↑ Nishimura, RA. (2002). "Cardiology patient pages. Aortic valve disease". Circulation. 106 (7): 770–2. PMID 12176943. Unknown parameter |month= ignored (help)
↑ Okafor I, Raghav V, Midha P, Kumar G, Yoganathan A (2016). "The hemodynamic effects of acute aortic regurgitation into a stiffened left ventricle resulting from chronic aortic stenosis". Am J Physiol Heart Circ Physiol. 310 (11): H1801–7. doi:10.1152/ajpheart.00161.2016. PMID 27106040.
↑ ^4.0 ^4.1 Lebowitz NE, Bella JN, Roman MJ, Liu JE, Fishman DP, Paranicas M, Lee ET, Fabsitz RR, Welty TK, Howard BV, Devereux RB (2000). "Prevalence and correlates of aortic regurgitation in American Indians: the Strong Heart Study". Journal of the American College of Cardiology. 36 (2): 461–7. PMID 10933358. Retrieved 2011-03-02. Unknown parameter |month= ignored (help)
↑ ^5.0 ^5.1 Dujardin KS, Enriquez-Sarano M, Schaff HV, Bailey KR, Seward JB, Tajik AJ (1999). "Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study". Circulation. 99 (14): 1851–7. PMID 10199882. Retrieved 2011-03-02. Unknown parameter |month= ignored (help)
↑ ^6.0 ^6.1 Ortiz JT, Shin DD, Rajamannan NM (2006). "Approach to the patient with bicuspid aortic valve and ascending aorta aneurysm". Current Treatment Options in Cardiovascular Medicine. 8 (6): 461–7. PMID 17078910. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ ^7.0 ^7.1 Keane MG, Pyeritz RE (2008). "Medical management of Marfan syndrome". Circulation. 117 (21): 2802–13. doi:10.1161/CIRCULATIONAHA.107.693523. PMID 18506019. Retrieved 2011-04-13. Unknown parameter |month= ignored (help)
↑ Seckeler MD, Hoke TR (2011). "The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease". Clinical Epidemiology. 3: 67–84. doi:10.2147/CLEP.S12977. PMC 3046187. PMID 21386976. |access-date= requires |url= (help)
↑ Bekeredjian, R.; Grayburn, PA. (2005). "Valvular heart disease: aortic regurgitation". Circulation. 112 (1): 125–34. doi:10.1161/CIRCULATIONAHA.104.488825. PMID 15998697. Unknown parameter |month= ignored (help)

Template:WH Template:WS CME Category::Cardiology

[pmid10190406-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ (1999). "Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study)". The American Journal of Cardiology. 83 (6): 897–902. PMID 10190406. Retrieved 2011-12-27. Unknown parameter |month= ignored (help)

[Nishimura-2002-2] Nishimura, RA. (2002). "Cardiology patient pages. Aortic valve disease". Circulation. 106 (7): 770–2. PMID 12176943. Unknown parameter |month= ignored (help)

[pmid27106040-3] Okafor I, Raghav V, Midha P, Kumar G, Yoganathan A (2016). "The hemodynamic effects of acute aortic regurgitation into a stiffened left ventricle resulting from chronic aortic stenosis". Am J Physiol Heart Circ Physiol. 310 (11): H1801–7. doi:10.1152/ajpheart.00161.2016. PMID 27106040.

[pmid10933358-4] 4.0 ^4.1 Lebowitz NE, Bella JN, Roman MJ, Liu JE, Fishman DP, Paranicas M, Lee ET, Fabsitz RR, Welty TK, Howard BV, Devereux RB (2000). "Prevalence and correlates of aortic regurgitation in American Indians: the Strong Heart Study". Journal of the American College of Cardiology. 36 (2): 461–7. PMID 10933358. Retrieved 2011-03-02. Unknown parameter |month= ignored (help)

[pmid10199882-5] 5.0 ^5.1 Dujardin KS, Enriquez-Sarano M, Schaff HV, Bailey KR, Seward JB, Tajik AJ (1999). "Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study". Circulation. 99 (14): 1851–7. PMID 10199882. Retrieved 2011-03-02. Unknown parameter |month= ignored (help)

[pmid17078910-6] 6.0 ^6.1 Ortiz JT, Shin DD, Rajamannan NM (2006). "Approach to the patient with bicuspid aortic valve and ascending aorta aneurysm". Current Treatment Options in Cardiovascular Medicine. 8 (6): 461–7. PMID 17078910. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid18506019-7] 7.0 ^7.1 Keane MG, Pyeritz RE (2008). "Medical management of Marfan syndrome". Circulation. 117 (21): 2802–13. doi:10.1161/CIRCULATIONAHA.107.693523. PMID 18506019. Retrieved 2011-04-13. Unknown parameter |month= ignored (help)

[pmid21386976-8] Seckeler MD, Hoke TR (2011). "The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease". Clinical Epidemiology. 3: 67–84. doi:10.2147/CLEP.S12977. PMC 3046187. PMID 21386976. |access-date= requires |url= (help)

[Bekeredjian-2005-9] Bekeredjian, R.; Grayburn, PA. (2005). "Valvular heart disease: aortic regurgitation". Circulation. 112 (1): 125–34. doi:10.1161/CIRCULATIONAHA.104.488825. PMID 15998697. Unknown parameter |month= ignored (help)

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

@@ Line 1: / Line 1: @@
-{{Aortic insufficiency}}
+__NOTOC__
+{| class="infobox" style="float:right;"
-{{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S., [[Lakshmi Gopalakrishnan]], M.B.B.S.
+|-
+| [[File:Siren.gif|30px|link=Aortic regurgitation resident survival guide]]|| <br> || <br>
+| [[Aortic regurgitation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
+|}
+{{aortic insufficiency}}
+{{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{USAMA}}
 ==Overview==
-The prevalence of aortic regurgitation varies with age, disease severity, gender and race<ref name="pmid10190406">{{cite journal |author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ |title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) |journal=[[The American Journal of Cardiology]] |volume=83 |issue=6 |pages=897–902 |year=1999 |month=March |pmid=10190406 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(98)01064-9 |accessdate=2011-12-27}}</ref>. Aortic insufficiency is unusual before the age of 50 and then increased progressively.
+The prevalence of aortic regurgitation varies with age, geographic location, and gender.<ref name="pmid10190406">{{cite journal |author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ |title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) |journal=[[The American Journal of Cardiology]] |volume=83 |issue=6 |pages=897–902 |year=1999 |month=March |pmid=10190406 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(98)01064-9 |accessdate=2011-12-27}}</ref> aortic regurgitation is unusual before the age of 50 and then increases progressively later in life. Worldwide the most common cause of aortic regurgitation is the [[rheumatic heart disease]], particularly in the Asia, the Middle East, and the North Africa. In the United States, [[senile]] degenerative [[calcific aortic valve disease]] and [[bicuspid aortic valve]] disease are the most common causes.<ref name="Nishimura-2002">{{Cite journal  | last1 = Nishimura | first1 = RA. | title = Cardiology patient pages. Aortic valve disease. | journal = Circulation | volume = 106 | issue = 7 | pages = 770-2 | month = Aug | year = 2002 | doi =  | PMID = 12176943 }}</ref>
-There are increased number of diagnosed cases of aortic regurgitation due to the widespread use of [[echocardiography]], many cases are trivial regurgitation in healthy subjects.
+==Epidemiology and Demographics==
+===Prevalence===
+The Framingham Heart Study, a prospective epidemiological study, evaluated the [[prevalence]] and severity of aortic regurgitation and other valvular diseases by color [[Doppler]] examinations in 1,696 men and 1,893 women.  The study revealed that the prevalence of aortic regurgitation (ranging in severity from trace to ≥ moderate regurgitation) is 13.0% in men and 8.5% in women.<ref name="pmid10190406">{{cite journal| author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL et al.| title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) | journal=Am J Cardiol | year= 1999 | volume= 83 | issue= 6 | pages= 897-902 | pmid=10190406 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10190406  }} </ref> <ref name="pmid27106040">{{cite journal| author=Okafor I, Raghav V, Midha P, Kumar G, Yoganathan A| title=The hemodynamic effects of acute aortic regurgitation into a stiffened left ventricle resulting from chronic aortic stenosis. | journal=Am J Physiol Heart Circ Physiol | year= 2016 | volume= 310 | issue= 11 | pages= H1801-7 | pmid=27106040 | doi=10.1152/ajpheart.00161.2016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27106040  }} </ref>
-In a population-based cohort study by Framingham Heart; [[aortic regurgitation]] (more than or equal to trace severity on echocardiography) found to present in 13 percent of men and 8.5 percent of women<ref name="pmid10190406">{{cite journal |author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ |title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) |journal=[[The American Journal of Cardiology]] |volume=83 |issue=6 |pages=897–902 |year=1999 |month=March |pmid=10190406 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(98)01064-9 |accessdate=2011-12-27}}</ref>.
+===Age===
+The prevalence of aortic regurgitation increases with age.<ref name="pmid10190406">{{cite journal |author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ |title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) |journal=[[The American Journal of Cardiology]] |volume=83 |issue=6 |pages=897–902 |year=1999 |month=March |pmid=10190406 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(98)01064-9 |accessdate=2011-03-02}}</ref><ref name="pmid10933358">{{cite journal |author=Lebowitz NE, Bella JN, Roman MJ, Liu JE, Fishman DP, Paranicas M, Lee ET, Fabsitz RR, Welty TK, Howard BV, Devereux RB |title=Prevalence and correlates of aortic regurgitation in American Indians: the Strong Heart Study |journal=[[Journal of the American College of Cardiology]] |volume=36 |issue=2 |pages=461–7 |year=2000 |month=August |pmid=10933358 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(00)00744-0 |accessdate=2011-03-02}}</ref><ref name="pmid10199882">{{cite journal |author=Dujardin KS, Enriquez-Sarano M, Schaff HV, Bailey KR, Seward JB, Tajik AJ |title=Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study |journal=[[Circulation]] |volume=99 |issue=14 |pages=1851–7 |year=1999 |month=April |pmid=10199882 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10199882 |accessdate=2011-03-02}}</ref> It 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 regurgitation much earlier in life.<ref name="pmid17078910">{{cite journal |author=Ortiz JT, Shin DD, Rajamannan NM |title=Approach to the patient with bicuspid aortic valve and ascending aorta aneurysm |journal=[[Current Treatment Options in Cardiovascular Medicine]] |volume=8 |issue=6 |pages=461–7 |year=2006 |month=December |pmid=17078910 |doi= |url= |accessdate=2011-04-13}}</ref><ref name="pmid18506019">{{cite journal |author=Keane MG, Pyeritz RE |title=Medical management of Marfan syndrome |journal=[[Circulation]] |volume=117 |issue=21 |pages=2802–13 |year=2008 |month=May |pmid=18506019 |doi=10.1161/CIRCULATIONAHA.107.693523 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18506019 |accessdate=2011-04-13}}</ref>
-==Prevalence==
+Shown below are tables depicting the prevalence of AR by age and severity in men and women according the results of the Framingham Heart Study.<ref name="pmid10190406">{{cite journal| author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL et al.| title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) | journal=Am J Cardiol | year= 1999 | volume= 83 | issue= 6 | pages= 897-902 | pmid=10190406 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10190406  }} </ref>
-There are two broad underlying causes of [[aortic insufficiency]]:
-# Disease of the [[aortic valve]] itself.
+{|
-# Disease of the aortic root leading to dilation and regurgitation of the aortic valve.
+|-
+|style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center | '''Severity of AR''' ||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center colspan= 5|'''Prevalence of AR by age in men'''
+|-
+|style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center | ||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center | '''26-29''' ||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center | '''40-49''' ||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center | '''50-59''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''60-69''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''70-83'''
+|-
+|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''No AR (%)''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |96.7 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |95.4 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |91.1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |74.3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |75.6
+|-
+|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''Trace (%)''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |3.3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |2.9 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |4.7 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |13 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |10
+|-
+|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''Mild (%)''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |0 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | 1.4|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |3.7 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |12.1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |12.2
+|-
+|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''Moderate or severe (%)''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |0.3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |0.5 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |0.6 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |2.2
+|}
-Aortic regurgitation secondary to dilation of the ascending aorta has overtaken valvular aortic disease as the most common cause of aortic regurgitation.
+{|
+|-
-The prevalence of aortic insufficiency increases with age with higher severity in men than in women<ref name="pmid10190406">{{cite journal |author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ |title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) |journal=[[The American Journal of Cardiology]] |volume=83 |issue=6 |pages=897–902 |year=1999 |month=March |pmid=10190406 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(98)01064-9 |accessdate=2011-03-02}}</ref><ref name="pmid10933358">{{cite journal |author=Lebowitz NE, Bella JN, Roman MJ, Liu JE, Fishman DP, Paranicas M, Lee ET, Fabsitz RR, Welty TK, Howard BV, Devereux RB |title=Prevalence and correlates of aortic regurgitation in American Indians: the Strong Heart Study |journal=[[Journal of the American College of Cardiology]] |volume=36 |issue=2 |pages=461–7 |year=2000 |month=August |pmid=10933358 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(00)00744-0 |accessdate=2011-03-02}}</ref><ref name="pmid9283535">{{cite journal |author=Klodas E, Enriquez-Sarano M, Tajik AJ, Mullany CJ, Bailey KR, Seward JB |title=Optimizing timing of surgical correction in patients with severe aortic regurgitation: role of symptoms |journal=[[Journal of the American College of Cardiology]] |volume=30 |issue=3 |pages=746–52 |year=1997 |month=September |pmid=9283535 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(97)00205-2 |accessdate=2011-03-02}}</ref><ref name="pmid10199882">{{cite journal |author=Dujardin KS, Enriquez-Sarano M, Schaff HV, Bailey KR, Seward JB, Tajik AJ |title=Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study |journal=[[Circulation]] |volume=99 |issue=14 |pages=1851–7 |year=1999 |month=April |pmid=10199882 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10199882 |accessdate=2011-03-02}}</ref>.
+|style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center | '''Severity of AR''' ||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center colspan=5|'''Prevalence of AR by age in women'''
+|-
+|style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center|  || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''26-29''' ||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center | '''40-49''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''50-59''' ||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center | '''60-69''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''70-83'''
+|-
+|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''No AR (%)''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |98.9|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |96.6 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |92.4 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |86.9 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |73
+|-
+|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''Trace (%)''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |1.1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |2.7 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |5.5 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |6.3|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |10.1
+|-
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Mild (%)''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |0.7 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |1.9 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |6 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |14.6
+|-
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Moderate or severe (%)''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |0.2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |0.8 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |2.3
+|}
+===Gender===
+aortic regurgitation is more common in men than in women.<ref name="pmid10190406">{{cite journal |author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ |title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) |journal=[[The American Journal of Cardiology]] |volume=83 |issue=6 |pages=897–902 |year=1999 |month=March |pmid=10190406 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(98)01064-9 |accessdate=2011-03-02}}</ref><ref name="pmid10933358">{{cite journal |author=Lebowitz NE, Bella JN, Roman MJ, Liu JE, Fishman DP, Paranicas M, Lee ET, Fabsitz RR, Welty TK, Howard BV, Devereux RB |title=Prevalence and correlates of aortic regurgitation in American Indians: the Strong Heart Study |journal=[[Journal of the American College of Cardiology]] |volume=36 |issue=2 |pages=461–7 |year=2000 |month=August |pmid=10933358 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(00)00744-0 |accessdate=2011-03-02}}</ref><ref name="pmid10199882">{{cite journal |author=Dujardin KS, Enriquez-Sarano M, Schaff HV, Bailey KR, Seward JB, Tajik AJ |title=Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study |journal=[[Circulation]] |volume=99 |issue=14 |pages=1851–7 |year=1999 |month=April |pmid=10199882 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10199882 |accessdate=2011-03-02}}</ref> 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.<ref name="pmid10190406">{{cite journal |author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ |title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) |journal=[[The American Journal of Cardiology]] |volume=83 |issue=6 |pages=897–902 |year=1999 |month=March |pmid=10190406 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(98)01064-9 |accessdate=2011-12-27}}</ref> The higher prevalence of [[marfan syndrome]] and [[bicuspid aortic valve]] in males could explain in part the greater prevalence of aortic regurgitation in men.<ref name="pmid17078910">{{cite journal |author=Ortiz JT, Shin DD, Rajamannan NM |title=Approach to the patient with bicuspid aortic valve and ascending aorta aneurysm |journal=[[Current Treatment Options in Cardiovascular Medicine]] |volume=8 |issue=6 |pages=461–7 |year=2006 |month=December |pmid=17078910 |doi= |url= |accessdate=2011-04-13}}</ref><ref name="pmid18506019">{{cite journal |author=Keane MG, Pyeritz RE |title=Medical management of Marfan syndrome |journal=[[Circulation]] |volume=117 |issue=21 |pages=2802–13 |year=2008 |month=May |pmid=18506019 |doi=10.1161/CIRCULATIONAHA.107.693523 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18506019 |accessdate=2011-04-13}}</ref>
+===Race===
+The prevalence of aortic regurgitation 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 the Asia, the Middle East, and the North Africa.<ref name="pmid21386976">{{cite journal |author=Seckeler MD, Hoke TR |title=The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease |journal=[[Clinical Epidemiology]] |volume=3 |issue= |pages=67–84 |year=2011 |pmid=21386976 |pmc=3046187 |doi=10.2147/CLEP.S12977 |url= |accessdate=2011-04-13}}</ref>
+===Developed Countries===
+In developed countries where [[rheumatic heart disease]] is rare, [[aortic regurgitation]] may be due to [[bicuspid aortic valve]] disease or [[senile]] degenerative [[calcific aortic valve disease]] which may present in the fourth to sixth decade. [[Endocarditis]] and [[aortic dissection]] are other causes. The prevalence of any aortic regurgitation in the Framingham study was reported to be 4.9%, with regurgitation of moderate or greater severity occurring in 0.5%.<ref name="pmid10190406">{{cite journal |author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ |title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) |journal=[[The American Journal of Cardiology]] |volume=83 |issue=6 |pages=897–902 |year=1999 |month=March |pmid=10190406 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(98)01064-9 |accessdate=2011-04-13}}</ref>
 ===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.
+In developing countries, [[rheumatic heart disease]] is the most common cause of [[aortic regurgitation]] and may present in second or third decade of life.<ref name="Bekeredjian-2005">{{Cite journal  | last1 = Bekeredjian | first1 = R. | last2 = Grayburn | first2 = PA. | title = Valvular heart disease: aortic regurgitation. | journal = Circulation | volume = 112 | issue = 1 | pages = 125-34 | month = Jul | year = 2005 | doi = 10.1161/CIRCULATIONAHA.104.488825 | PMID = 15998697 }}</ref>
-===Developed Countries===
-In developed countries where [[rheumatic heart disease]] is rare, [[aortic insufficiency]] may be due to bi-cuspid aortic valve disease or degenerative disease which may present in the fourth to sixth decade. [[Endocarditis]] and [[aortic dissection]] are other causes. The prevalence of aortic insufficiency in the Framingham study  was reported to be 4.9%, with regurgitation of moderate or greater severity occurring in 0.5%<ref name="pmid10190406">{{cite journal |author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ |title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) |journal=[[The American Journal of Cardiology]] |volume=83 |issue=6 |pages=897–902 |year=1999 |month=March |pmid=10190406 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(98)01064-9 |accessdate=2011-04-13}}</ref>.
-===Race===
-The prevalence of aortic insufficiency does not show any variation with races in United States. However, internationally there is significant variation in the prevalence of predisposing conditions such as rheumatic heart disease <ref name="pmid">{{cite journal |author=Feldman T |title=Rheumatic heart disease |journal=[[Current Opinion in Cardiology]] |volume=11 |issue=2 |pages=126–30 |year=1996 |month=March |pmid= |doi= |url= |accessdate=2011-04-13}}</ref><ref name="pmid21386976">{{cite journal |author=Seckeler MD, Hoke TR |title=The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease |journal=[[Clinical Epidemiology]] |volume=3 |issue= |pages=67–84 |year=2011 |pmid=21386976 |pmc=3046187 |doi=10.2147/CLEP.S12977 |url= |accessdate=2011-04-13}}</ref>.
-===Gender===
-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 <ref name="pmid10190406">{{cite journal |author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ |title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) |journal=[[The American Journal of Cardiology]] |volume=83 |issue=6 |pages=897–902 |year=1999 |month=March |pmid=10190406 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(98)01064-9 |accessdate=2011-04-13}}</ref><ref name="pmid18506019">{{cite journal |author=Keane MG, Pyeritz RE |title=Medical management of Marfan syndrome |journal=[[Circulation]] |volume=117 |issue=21 |pages=2802–13 |year=2008 |month=May |pmid=18506019 |doi=10.1161/CIRCULATIONAHA.107.693523 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18506019 |accessdate=2011-04-13}}</ref><ref name="pmid17078910">{{cite journal |author=Ortiz JT, Shin DD, Rajamannan NM |title=Approach to the patient with bicuspid aortic valve and ascending aorta aneurysm |journal=[[Current Treatment Options in Cardiovascular Medicine]] |volume=8 |issue=6 |pages=461–7 |year=2006 |month=December |pmid=17078910 |doi= |url= |accessdate=2011-04-13}}</ref>.
-===Age===
-The prevalence and severity of AR increase with age, with higher prevalence of chronic sever aortic insufficiency at 70 years. However people with congenital aortic valve/root defects such as bicuspid aortic valve and marfan syndrome develop aortic insufficiency much earlier <ref name="pmid10190406">{{cite journal |author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ |title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) |journal=[[The American Journal of Cardiology]] |volume=83 |issue=6 |pages=897–902 |year=1999 |month=March |pmid=10190406 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(98)01064-9 |accessdate=2011-04-13}}</ref><ref name="pmid17078910">{{cite journal |author=Ortiz JT, Shin DD, Rajamannan NM |title=Approach to the patient with bicuspid aortic valve and ascending aorta aneurysm |journal=[[Current Treatment Options in Cardiovascular Medicine]] |volume=8 |issue=6 |pages=461–7 |year=2006 |month=December |pmid=17078910 |doi= |url= |accessdate=2011-04-13}}</ref><ref name="pmid18506019">{{cite journal |author=Keane MG, Pyeritz RE |title=Medical management of Marfan syndrome |journal=[[Circulation]] |volume=117 |issue=21 |pages=2802–13 |year=2008 |month=May |pmid=18506019 |doi=10.1161/CIRCULATIONAHA.107.693523 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18506019 |accessdate=2011-04-13}}</ref>.
 ==References==
 {{Reflist|2}}
+{{WH}}
+{{WS}}
+[[CME Category::Cardiology]]
+[[Category:Disease]]
 [[Category:Cardiology]]
+[[Category:Valvular heart disease]]
-{{WH}}
+[[Category:Congenital heart disease]]
-{{WS}}
+[[Category:Surgery]]
+[[Category:Cardiac surgery]]
+[[Category:Emergency medicine]]
+[[Category:Intensive care medicine]]
+[[Category:Up-To-Date cardiology]]
+[[Category:Up-To-Date]]