From the Guidelines
The primary risk factor for developing mitral stenosis is a history of rheumatic fever, which remains the most common cause worldwide, as stated in the 2008 guidelines for the management of patients with valvular heart disease 1.
Risk Factors for Mitral Stenosis
The development of mitral stenosis is primarily attributed to rheumatic fever, an inflammatory reaction to group A streptococcal infection, leading to valve damage through autoimmune mechanisms, with symptoms typically appearing 10-20 years after the initial infection.
- Other risk factors include:
- Congenital heart defects present at birth
- Calcium deposits forming around the mitral valve with age
- Radiation therapy to the chest
- Certain medications like ergotamine derivatives and methysergide
- Rare conditions such as carcinoid syndrome, rheumatoid arthritis, and systemic lupus erythematosus
- Infective endocarditis can also cause mitral valve damage leading to stenosis
Demographic Considerations
Mitral stenosis is more common in women than men, with a ratio of 2:1, as noted in the 2008 guidelines 1.
- Prevalence is higher in developing countries where rheumatic fever remains endemic due to limited access to antibiotics for treating streptococcal infections.
Prevention
Early detection and treatment of strep throat with appropriate antibiotics like penicillin can prevent rheumatic fever and subsequent mitral stenosis development, as implied by the guidelines for the primary prevention of stroke 1.
- The 2014 guidelines for the primary prevention of stroke also highlight the importance of managing valvular heart disease to reduce the risk of embolic stroke 1.
From the Research
Risk Factors for Mitral Stenosis
The risk factors for developing mitral stenosis include:
- Acute rheumatic fever (RF), which is the major etiology for mitral stenosis (MS) 2, 3, 4
- Group A β-hemolytic streptococcal infection, which can lead to acute rheumatic fever 2, 4
- Rheumatic heart disease (RHD), which is a notable cause of morbidity and mortality in resource-poor settings around the world 3, 4
- Immigration from non-industrialized countries where rheumatic heart disease (RHD) is higher 2
- Ethnicity, with Bedouin patients having a higher risk for progressive disease 5
Demographic Risk Factors
Demographic risk factors for mitral stenosis include:
- Age, with adults presenting with nonsevere disease having a higher risk of progression 5
- Geographic location, with developing countries having a higher prevalence of mitral stenosis 6, 3, 4
- Socioeconomic status, with poverty being a particular issue for those living with rheumatic heart disease (RHD) 4