Heart Valve Disease: What We Don’t Know is Killing Us
Association of Black Cardiologists and Alliance for Aging Research Op-ed
by Susan Peschin, MHS, is President and CEO of the Alliance for Aging Research and Seun Alli, MD and Aaron Horne, Jr., MD, MBA, MPH, Co-Chairs of the Association of Black Cardiologists Valvular Heart Disease Program
When most people think of heart disease they think of heart attacks or heart failure. Many Americans have never heard of heart valve disease. In fact, a 2016 survey found that three out of four Americans knew little to nothing about it.
So, what is heart valve disease and why should you care?
The heart has four valves, and their job is to keep blood flowing in and out of the heart. Heart valve disease develops when one or more of these valves are damaged, and can lead to major complications, including death. At least five million Americans have heart valve disease and an estimated 25,000 people die from it each year.
Heart valve disease can affect the very young. Babies can be born with heart valve problems that sooner or later develop into heart valve disease. But heart valve disease more commonly occurs in adults as a result of wear and tear on the heart, including gradual damage that happens as we age. In fact, one in eight people age 75 and older have moderate to severe heart valve disease.
This risk of wear and tear on the heart increases with diabetes, high blood pressure, or heart failure; and if you are overweight or obese. Risk also increases if you’ve had a previous heart condition or an infection that impacted the heart, or treatment for cancer in the chest.
Many of the risk factors for heart valve disease are higher in African Americans than in whites. African Americans have the highest prevalence of high blood pressure in the world, and compared to whites, African Americans develop high blood pressure at earlier ages, and with much higher blood pressure levels. African-American individuals also develop heart failure before the age of 50 at 20 times the rate of whites; are twice as likely to develop diabetes as whites; and are more likely to have serious complications such as kidney disease.
While we know that African Americans skew younger with the onset of heart valve disease risk factors, less is known about whether health care providers are detecting and treating heart valve disease in these patients. An August 2017 American Journal of Cardiology study found that the odds of being referred to a cardiothoracic surgeon for treatment of heart valve disease were 54% lower in African American patients compared with whites. Additionally, research shows that African Americans with heart valve disease are 33% more likely to refuse treatment than white patients. Yet, when they were treated, both groups had similar 3-year survival rates. The importance of understanding the reasons behind lower rates of referral and treatment refusal among African Americans cannot be overstated. This is literally a matter of life and death.
Unfortunately, the medical professional guidelines for diagnosing and treating heart valve disease do not yet include attention to racial disparities. There needs to be increased research on the causes and solutions to these disparities and we need to get to the bottom of why these differences exist. For example, potential causes include disparities in access to diagnosis and treatment for heart valve disease, differences in what patients prefer, or biases on the part of providers.
We need to start a national conversation about heart valve disease for all Americans, especially those who are underserved. This is why the Alliance for Aging Research, the Association of Black Cardiologists, and nearly 40 other organizations come together to recognize National Heart Valve Disease Awareness Day on February 22 each year. This year’s theme of “Listen to Your Heart” encourages everyone to know their risk factors for heart valve disease, listen to their hearts and get them checked regularly, and know where to turn if they notice symptoms.
Visit www.ValveDiseaseDay.org to learn more.