Heart valve disease is on the rise. Here’s all you need to know
A quarter of people over 60 have heart valve disease, yet many of us are unaware of it. We uncover the warning signs and examine the treatments available.
A quarter of people over 60 have heart valve disease, yet many of us are unaware of it. We uncover the warning signs and examine the treatments available.
Most of us associate heart disease with the sudden drama of a heart attack. But heart valve disease, one of the most serious – and increasingly common – heart conditions in later life often arrives far more gradually.
It happens when one or more of the heart’s four valves stops working properly, forcing the heart to work harder to keep blood flowing. This could be when the valve leaks (regurgitation), or becomes stiff or narrowed (stenosis).
Around 1.5 million people aged 65-plus in the UK have heart valve disease, but the true number could be higher. Research from the University of East Anglia in 2024 found that more than one in four healthy, symptom-free over-60s had undiagnosed valve disease. Cases are predicted to double by 2040 and triple by 2060, prompting some experts to call it “the next cardiac epidemic”.
The good news is that early detection is easy. The charity Heart Valve Voice is urging anyone with tell-tale symptoms to ask their GP for a simple stethoscope check. They’re calling their campaign SLOW after the four key symptoms:
If a heart murmur (an unusual sound between beats) is detected, this can trigger further tests, such as an echocardiogram, to provide a clear diagnosis.
Part of the challenge is that the symptoms of heart valve disease – breathlessness, tiredness, dizziness – are easily written off as normal ageing or part of everyday life. Yet they can also be subtle clues that the heart is struggling.
Caz Wilson, 60, who lives in Burntwood, Staffordshire, was born with a heart murmur, which for years caused little trouble. But then in 2019, Caz, a keen runner, began feeling increasingly tired and breathless. “Although I was fit and active, and had practised kung fu for 25 years, the warm-up would be so shattering, I’d have to sit down,” she says.
“On walks, I’d slow down to ‘take in the view’ or suggest a coffee stop. Well-meaning friends would say that they, too, felt tired, making it easy to convince myself I didn’t have a problem.”
A routine check-up revealed that Caz's mitral valve leak had become severe, and that she needed urgent open-heart surgery. She had the operation at Royal Stoke University Hospital, Stoke-on-Trent, in 2020. Recovery was slow, with setbacks including atrial fibrillation, but six months later she was back on her feet.
Caz’s story is not unique. “Valve disease often rumbles along quietly for years,” says Lognathen Balacumaraswami, consultant cardiothoracic surgeon at the Royal Stoke University Hospital.
“But over time, there is strain on the heart, which leads to a change in how it pumps.”
That’s when breathlessness, fatigue, dizziness, chest pain and – later – swollen legs, more severe breathlessness, palpitations and other signs of heart failure appear.
“Waiting until this stage can mean damage that isn’t fully reversible even after the valve is fixed,” explains Balacumaraswami.
For years, heart-valve disease has been attributed to age-related wear and tear, but recent research paints a more complex picture. Calcification (the build-up of calcium in the heart valves that causes them to narrow and stiffen), once thought passive, is now emerging as an active biological process. Blood fats deposit on the valve, inflammation develops, and valve cells begin to behave like bone-building cells,laying down calcium.
Genetics may also play a role. Defects in collagen, the gluey protein in connective tissue, may predispose some people to specific valve conditions. Long-term high blood pressure is another potential culprit in common valve problems in older people, including aortic stenosis, aortic regurgitation and mitral regurgitation. Insulin resistance, linked to being overweight, obesity and type 2 diabetes, is also connected to aortic stenosis.
These discoveries are transforming prevention, detection and treatment with minimally invasive procedures and precision repair strategies, making for easier, less disruptive interventions.
Medications, such as ACE inhibitors, beta blockers, diuretics, anticoagulants and anti-arrhythmic drugs, can ease strain on the heart and reduce symptoms in mild cases. But as the disease progresses, surgery is the only solution.
Minimally invasive procedures, which use thin tubes threaded through blood vessels to repair or replace faulty valves, have revolutionised treatment for many, especially older or higher-risk people. However, less invasive doesn’t always equal better, cautions Balacumaraswami. For younger, fitter patients, traditional open-heart surgery still offers the most durable results.
The best known of the new approaches is TAVI (Transcatheter Aortic Valve Implantation), which is used to treat aortic stenosis, the most common heart-valve problem in older people. It was transformative for 87-year-old John Deane from East Sussex. The former mountain-walking guide in Spain had a heart attack requiring three stents in 2008. But in 2022, a routine check revealed that his aortic valve had narrowed severely.
“I’d noticed increasing breathlessness, difficulty walking uphill, and waning energy levels,” says John.
“I needed longer rests and was struggling to keep warm.”
Given the risks of open-heart surgery at his age (then 84), John opted for TAVI at the Royal Sussex County Hospital in Brighton. Within weeks, he was walking again; a month later, he was driving. Now he regularly walks a 3.5km trail near his home and volunteers on the Bluebell Railway, doing hard physical work that many people half his age would struggle with.
New European guidelines issued in August 2025, which lower the eligible age for TAVI from 75 to 70, and recommend it for people with severe aortic stenosis even without symptoms, are expected to make the procedure more available. But with an 11-fold variability in rates across different regions of the UK, there is a significant postcode lottery.
Waiting can be dangerous. “Without treatment, the disease can worsen rapidly,” warns Wil Woan at Heart Valve Voice.
“Patients may go into heart failure or have a heart attack. Half will die within two years.”
Scientists are exploring new ways to protect and even regenerate valve tissue.
“Early small studies of drugs that could potentially slow or stop calcification are promising but we need larger trials,” explains Dr Mohammad Alkhalil, consultant cardiologist at Newcastle’s Freeman Hospital.
Valve replacement treatment is also evolving.
“We now have a range of slightly different valves for keyhole procedures, with research focusing on matching the right valve to the patient’s anatomy,” says Dr Alkhalil.
Better screening could also be on the horizon. Dr Alkhalil is exploring using lasers to detect valve disease. AI could also be harnessed to monitor people with moderate heart valve disease, relieving pressure on the NHS by initiating regular follow-ups and echocardiograms.
As for Caz, life post-heart surgery took an unexpected turn when she revived a childhood passion for sewing. Starting with Covid masks, she quickly moved to clothes for friends and family. This culminated in her victory on the BBC’s The Great British Sewing Bee in 2025, for which she made a stunning dress depicting a symbolic heart and ribcage, dedicated to the NHS staff who saved her life.
Her advice?
“Don’t panic, but don’t delay in seeking help: if something worries you, even a bit, get it checked.”
Hero image credit: GettyImages
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