VHD is increasingly recognized as a progressive condition that begins years before severe disease becomes clinically evident. A population-based analysis from the STAAB cohort examined how frequently individuals progress across guideline-defined VHD stages and which factors predict disease progression.

The analysis included 4943 community-dwelling adults aged 30 to 79 years without self-reported heart failure who underwent baseline transthoracic echocardiography between 2013 and 2017. At baseline, 24% had no VHD, 54% were classified as stage A, 21% as stage B, and 0.3% as stage C or D. VHD prevalence increased markedly with advancing age.

Among 3833 participants with follow-up echocardiography after a median of 34 months, 10% of those in stage A and 1.3% of those in stage B progressed to a higher stage or required valve intervention. Progression rates rose steeply with age. In participants aged 60 to 69 years, progression occurred in 15% of stage A and 1.6% of stage B. In those aged 70 to 79 years, progression increased to 25% and 2.6%, respectively.

In multivariable age-adjusted models, higher E/e’ independently predicted progression from stage A, whereas elevated NT-proBNP independently predicted progression from stage B. Continuous analyses of aortic stenosis progression showed additional associations with older age, higher body mass index, diabetes, and higher baseline peak aortic jet velocity.

These findings demonstrate that VHD progression is common in the general population, particularly at older ages. Echocardiographic indices and circulating biomarkers emerged as stage-specific predictors, supporting their role in identifying individuals at higher risk for early progression.