The global burden of calcified aortic valve stenosis: epidemiology, risk factors, disparities, and future perspectives - a narrative review.

Calcific aortic valve stenosis (CAVS) is the most common valvular heart disease requiring intervention. Progressive fibrocalcific thickening of the valve leaflets results in left ventricular outflow tract obstruction. Once symptoms emerge, CAVS is associated with high morbidity and mortality, contributing to over 100,000 deaths globally each year. The worldwide prevalence of CAVS is rising, affecting a 9.6 to 12.6 million people according to Global Disease Burden estimates, thereby becoming an increasingly public health burden. This narrative review summarizes current knowledge on the epidemiology, risk factors, pathophysiology, and disparities associated with CAVS. Age and congenital leaflet abnormalities are the most substantial risk factors for developing CAVS. Classical cardiovascular risk factors such as hypertension, dyslipidemia, obesity, and smoking increase disease burden, but also valve-specific risk factors such as lipoprotein(a) and valve calcification accelerate disease progression. Furthermore, we examine sex differences in valvular and myocardial remodeling, as well as sex-related disparities in diagnosis and treatment. Additionally, we explore racial and ethnic variations in disease epidemiology and management, acknowledging that significant disparities in the diagnosis and treatment of CAVS. The anticipated rise in disease burden due to an aging population and persistent cardiovascular risk factors underscores the need for comprehensive strategies. Currently, there are no targeted medical therapies proven to prevent onset or halt progression of these diseases. Primary intervention including aggressive risk factor modification is needed to effectively reduce future morbidity and mortality. Public health initiatives, lifestyle interventions, and policy measures to reduce disparities will play pivotal roles in addressing this health challenge.