GLOBAL DISTRIBUTION OF AORTIC VALVE STENOSIS ACCORDING TO ETHNIC POPULATIONS: EPIDEMIOLOGY, GENETIC SUSCEPTIBILITY, AND CLINICAL IMPLICATIONS

Abstract

Aortic valve stenosis (AS) represents the most frequent valvular heart disease requiring surgical or transcatheter intervention in developed countries and constitutes an increasing global health burden due to population aging and improved life expectancy. Although the prevalence of aortic stenosis has traditionally been associated with elderly Caucasian populations, accumulating evidence suggests significant ethnic variations in disease prevalence, age at presentation, pathological mechanisms, and clinical outcomes. These differences appear to result from complex interactions between genetic background, environmental exposure, socioeconomic factors, access to healthcare, and distribution of cardiovascular risk factors. Caucasian populations, particularly those of European ancestry, demonstrate the highest reported prevalence of calcific aortic valve stenosis, partly related to increased longevity, higher frequency of bicuspid aortic valve disease, and genetic susceptibility involving pathways associated with lipid metabolism, inflammation, and valve calcification. In contrast, African populations appear to have lower rates of calcific aortic stenosis despite a higher prevalence of hypertension and other cardiovascular risk factors. Asian populations historically showed lower rates of severe aortic stenosis; however, rapid demographic aging and westernization of lifestyle have resulted in a substantial increase in disease burden. Hispanic and South Asian populations represent heterogeneous groups in which metabolic factors, healthcare disparities, and genetic admixture influence disease expression. Understanding ethnic differences in aortic stenosis epidemiology is increasingly important for cardiovascular prevention, early diagnosis, surgical planning, and allocation of healthcare resources. This review summarizes current knowledge regarding global ethnic variations in aortic valve stenosis, emphasizing epidemiological patterns, genetic determinants, and implications for contemporary cardiac practice.