Prevalence of Previously Undetected Moderate-to-Severe Valvular Heart Disease in Elderly Adults in Saudi Arabia

Background Population aging is increasing the burden of non-communicable diseases, including non-rheumatic valvular heart disease (VHD), yet the epidemiology of VHD remains poorly characterized in many middle-income countries. In the Kingdom of Saudi Arabia (KSA), where the older adult population is rapidly expanding, data on previously undiagnosed VHD are lacking. This study estimated the prevalence of previously undiagnosed moderate-to-severe VHD among older adults to inform future public health planning and healthcare delivery. Methods In this cross-sectional study, consecutive adults aged ≥ 60 years without known VHD underwent transthoracic echocardiography at a tertiary care center in Riyadh, KSA. Moderate-to-severe disease affecting the aortic, mitral, and/or tricuspid valves was assessed using guideline-recommended criteria. Prevalence estimates with exact 95% confidence intervals (CI) were calculated. An exploratory multivariable logistic regression was used to evaluate associations with demographic and cardiometabolic factors. Results A total of 512 participants (mean age 70.0 ± 7.2 years) underwent echocardiographic screening. The prevalence of any previously undiagnosed moderate-to-severe VHD was 9.6% (95% CI 7.2–12.5), while moderate-to-severe aortic stenosis was identified in 2.2% (95% CI 1.1–3.8). Exploratory multivariable analysis (N = 510) suggested increasing age was associated with higher odds of moderate-to-severe VHD. Conclusion A substantial proportion of older adults had previously undiagnosed moderate-to-severe VHD, suggesting an important hidden burden of disease in KSA. These findings address a critical gap in epidemiological evidence and support future population-based studies to define the national burden of VHD. They also provide evidence to inform health system planning, early detection strategies, and resource allocation as the population continues to age.