Aortic stenosis affects roughly 12.4% of adults over 75, making it one of the most common heart valve diseases in older populations. In younger adults, it’s relatively rare. The condition becomes dramatically more prevalent with each decade of life, and as populations age worldwide, the number of people living with it is expected to keep climbing.
Overall Prevalence by Age
Aortic stenosis is fundamentally an age-driven condition. Among adults under 50, severe cases occur in about 0.08% of the population. That number rises steadily with each decade until it reaches 3.8% in people 90 and older. The pattern holds across all racial and ethnic groups, though the steepness of the climb varies.
In community-based studies of elderly adults (generally defined as 75 and older), pooled data from nearly 10,000 subjects puts the overall prevalence of any degree of aortic stenosis at 12.4%. Most of those cases are mild. One large study found that about 4.3% of elderly patients had mild stenosis, while 0.7% had moderate to severe disease. Severe aortic stenosis specifically affects about 3.4% of people over 75.
Who Gets It More Often
Men are more likely to develop severe aortic stenosis than women, with roughly 38% higher odds after adjusting for other factors. The reasons aren’t entirely clear, but differences in valve calcification patterns and cardiovascular risk profiles likely play a role.
Race and ethnicity also matter. White and Hispanic adults have the highest rates of severe aortic stenosis, while Asian American and non-Hispanic Black adults are roughly half as likely to develop severe disease compared to White patients. These differences persist even after accounting for age and other health conditions like diabetes, which itself raises the risk by about 23%.
Congenital Risk: Bicuspid Aortic Valve
Not all aortic stenosis is a disease of aging. Between 0.5% and 2% of people are born with a bicuspid aortic valve, meaning the valve has two flaps instead of the usual three. This is the most common congenital heart valve defect, and it significantly accelerates valve wear. Population studies following these patients over 25 years found that 53% eventually needed valve replacement surgery. People with a bicuspid valve also face eight times the normal risk of aortic dissection, a dangerous tearing of the aorta wall. These patients often develop stenosis in their 50s or 60s rather than their 70s or 80s.
Symptoms Are More Common Than You’d Think
A widespread assumption is that aortic stenosis starts silently and only causes symptoms once it becomes severe. Real-world data tells a different story. In a large cohort of patients newly diagnosed with aortic stenosis, about 80% already had symptoms potentially linked to their valve disease at the time of diagnosis, regardless of severity. Even among patients with mild stenosis, 80% reported symptoms like shortness of breath, chest pain, or dizziness.
This matters because it challenges the idea that mild or moderate stenosis is always a “watch and wait” situation. It also suggests that many people may attribute their symptoms to aging or other conditions rather than recognizing them as signs of valve disease.
Severe Disease and What Happens Without Treatment
Among elderly patients with severe aortic stenosis, about three-quarters are symptomatic. Symptomatic severe stenosis is a serious diagnosis. In one UK study, patients who received valve replacement had a two-year survival rate of 96.3%, while those managed without surgery had a two-year survival of just 75%. That gap is significant and widens over time.
Despite this, roughly 40% of elderly patients with severe symptomatic aortic stenosis do not undergo surgical treatment. Some are too frail for open-heart surgery. Others decline intervention or aren’t referred for it. This treatment gap has narrowed somewhat with the rise of less invasive valve replacement procedures. In 2019, catheter-based valve replacements (where a new valve is delivered through a blood vessel rather than through open-chest surgery) surpassed traditional surgical replacements for the first time in the United States, with nearly 73,000 catheter-based procedures performed compared to about 57,600 surgical ones.
A Growing Public Health Challenge
Because aortic stenosis is so tightly linked to age, its prevalence is rising in step with demographic shifts. Populations across North America, Europe, and East Asia are aging rapidly, and the number of people over 75 is projected to grow substantially over the coming decades. Even without any change in the underlying rate of disease, the sheer number of affected individuals will increase. Combined with the fact that most cases involve symptoms that overlap with general aging (fatigue, breathlessness, reduced exercise tolerance), a large portion of cases may go unrecognized until the disease is advanced.