Debate. Asymptomatic severe aortic stenosis: when should we intervene? The clinician’s perspective

QUESTION: Can the prevalence of asymptomatic aortic stenosis and its various degrees of severity be estimated in the general population? ANSWER: Although estimates can be made, they undoubtedly underestimate the true prevalence of asymptomatic aortic stenosis (AS). What we know is that, according to the 2017 European Cardiovascular Disease Statistics, over 6 million new cases of cardiovascular disease are diagnosed each year in Europe, with over 50 million prevalent cases (a 30% increase since 2000). In Spain, this amounts to over 250 000 new cases of cardiovascular disease diagnosed each year, and over 4 million prevalent cases. If we focus on valvular heart disease, according to the latest Euro Heart Survey, AS is still the most widely diagnosed (41%) and frequently treated (45% of all procedures performed) severe valvular heart disease in the hospital setting. Undoubtedly, AS represents the highest burden of valvular heart disease among patients overall, and is even more significant among older adults. In the Olmsted County registry,1 the prevalence of AS was 0.5% (4.6% in patients older than 75 years, a rate very similar to that of the AGES-Reykjavík trial,2 where the prevalence of severe AS in patients older than 70 years was 4.3%.) If we look at asymptomatic...