Global Burden of Degenerative Mitral Valve Disease Continues to Rise

NEW YORK, NY—Due to an aging population and better diagnosis, the worldwide prevalence of degenerative mitral valve (MV) disease more than doubled between 1990 and 2023, from about 7 million to 16 million, with the trend expected to continue in the coming decades, according to data from the Global Burden of Disease (GBD) study.

The absolute number of deaths associated with the condition also rose over the same span, but age-adjusted mortality rates declined, Guido Ascione, MD (Cardiovascular Research Foundation, New York, NY), reported last week at New York Valves 2025.

That “suggests that access to care and introduction of new therapies may be having an impact on outcomes, but this actually appears to favor regions with higher sociodemographic index,” he said, adding, “There are huge opportunities for low-income countries to catch up.”

Lead discussant Mayra Guerrero, MD (Mayo Clinic, Rochester, MN), said this was “the most important presentation of this meeting.”

Though it’s not surprising that prevalence of degenerative MV disease would increase in an aging population, “this data offered a glimpse into future needs, highlighting the anticipated surge for need for mitral valve interventions in the coming years,” she said. “We must be prepared to expand our capacity to treat these patients.”

But “that’s the easy part,” Guerrero added. The tougher issue is the disparities in mortality that saw women and those from low-income countries faring worse despite having lower prevalence. “This raises an important concern. Is the prevalence really, truly lower or is the disease underdiagnosed? It seems likely that many of these patients are being underdiagnosed, undertreated, or treated too late, often without access to the latest transcatheter therapies that are necessary for those at high surgical risk.”

She stressed that “this is a serious and urgent problem, and we must treat this moment as a turning point, a call to action, to address these important healthcare disparities.”

Differences Across Sociodemographic Levels

The analysis used data from the GBD study, which incorporates information from population-based cohort studies, surveys, and administrative databases from 204 countries and territories and provides estimates for about 500 outcomes and risk factors. 

Presentation NY Valves 2025

Global and Regional Burden of Non-Rheumatic Degenerative Mitral Valve Disease: Implications for Transcatheter Therapies

The investigators identified degenerative MV disease using the standardized case definition—echocardiographic finding of prolapse or myxomatous degeneration of the mitral valve with at least moderate mitral regurgitation (MR grade ≥ 2). They excluded patients with secondary MR.

From 1990 to 2023, absolute prevalence increased by 126%. The trend was consistent in men and women, although prevalence was about twice as high in men.

We must treat this moment as a turning point, a call to action, to address these important healthcare disparities. Mayra Guerrero

The age-standardized prevalence rate, however, remained relatively stable over the same period. That shows that the main driver of the increase in absolute prevalence was the aging of the population, Ascione said. “On the other hand, [it indicates] that the diagnostic capabilities globally in terms of early diagnosis and identifying this disease better did not increase over the study time.”

In 2023, prevalence peaked in patients ages 70 to 74 years, with about 11 million people who were at least 70 years old having degenerative MV disease. That includes about 4.1 million who were at least 80 years old. “This has dramatic consequences when we think about treatment algorithms for the future,” Ascione said.

Prevalence also was greater in countries with a high sociodemographic index, an indicator of the overall development of a nation that takes into account income per capita, education levels, and fertility among women younger than 25 years. Ascione said that can be attributed to both better diagnostic capabilities and older populations in those parts of the world.

Mortality estimates came from death certificates that listed degenerative MV disease as the primary cause of death. The absolute number of deaths increased by 75% between 1990 and 2023, with that trend expected to continue up to 2050.

Age-adjusted mortality rates fell in both men and women, although they remained higher in women. Rates peaked at around 85 years of age.

There was an initial drop in age-standardized mortality from about 1990 to 2008 due to improvements in surgery, including standardization of techniques and advancements in pre- and postoperative care. After a brief period of stabilization, another decline started around 2017. “This is highly probably due to the progressive rise in transcatheter technologies that offer [a] treatment option to patients that were not treated before due to the high surgical risks,” Ascione said.

These gains appear confined largely to countries with a high sociodemographic index, where most of the diagnostic and treatment advancements are occurring. In fact, low-income countries saw a slight uptick in mortality rate, exceeding that seen in high-income countries after about 2017. This, Ascione said, is “probably due to a progressive increase in diagnosis that was not followed by an improvement in treatment.”

Where to Go From Here

Alluding to the impact TAVI has had on the treatment of severe aortic stenosis over the past two decades, Guerrero said that with mitral transcatheter edge-to-edge repair and transcatheter mitral valve replacement as tools, “we now must push to make mitral valve care a truly global movement, one that . . . ensures accessibility, standardization, and [reproducibility] for all patients, but regardless of sex and regardless of country of origin.”

Asked about how to address the observed disparities, Ascione said “we should start with optimizing diagnosis, early diagnosis, identifying the patients who are most likely to benefit from treatment. And then we should come up with algorithms . . . that account for the growing and aging population.”

Juan Granada, MD (Cardiovascular Research Foundation), a co-author of the study, said “this type of data is extremely important to create awareness so the companies actually know what the real problem is. We have a big access problem, this parity of care, inequality in our field, that needs to be addressed.”

Though “big data” should be carefully interpreted, the trends are informative, he indicated. Mortality rates overall are going down, “but when you see that goes in a different direction according to your socioeconomical status, I mean, it’s pretty alarming and depressing at the same time,” he said.