YOU’VE HEARD OF heart disease and coronary artery disease, but heart valve disease? Really? Yes, really. Your heart has four valves that open and close, directing the flow of blood as it cycles throughout your body, delivering oxygen and nutrients to your organs. But things can wrong—any valve may not open or close properly with serious consequences, including chest pain or fainting spells as your body becomes deprived of oxygen. Over time, damaged valves can lead to heart failure, arrhythmias, blood clots, and stroke. Here’s what puts you at risk for HVD.

Born With a Valve Defect
HVD can't always be prevented. According to the American Heart Association, there are at least 18 different types of congenital (meaning, you were born with it) heart defects. “There’s nothing you can do to prevent them,” says Deepak Vivek, M.D., a cardiologist at Orlando Health Heart and Vascular Institute in Florida. Bicuspid aortic valve disease is a defect that can disrupt blood flow because the malformed valve sometimes can’t open or close fully, forcing the heart to work harder than normal to pump blood. Dr. Vivek says that about one in 100 people are born with this defect.

Aging Into Valve Trouble
A major risk factor for HVD is aging. Calcium deposits can build up as you get older, causing your valves to thicken. In fact, about one in four people over the age of 65 show signs of mild thickening of their aortic valve, and one in eight people over 75 has moderate to severe thickening (called aortic stenosis), which hampers blood flow and causes damaging pressure to build in the heart. “Aortic stenosis most often results from degenerative changes” as people get up in years, leading to chest pain, shortness of breath, and passing out, says Dr. Vivek.

Left Valve Leakage
Dr. Vivek says the most common type of valve disease is mitral valve regurgitation. “That’s where the mitral valve, on the left side of the heart, does not close all the way,” he explains, leading to blood leaking into the left atrium rather than flowing forward into the left ventricle. Pressure then builds up in the lungs, leaving you feeling fatigued and short of breath. “Over time, that can lead to heart dilatation, or enlargement, and heart dysfunction, where the pump itself gives out because of the leakage,” adds Dr. Vivek. Heart failure or an abnormal heart rhythm (arrhythmia) can result.

HVD and Childhood Viral Infections
Being infected with rheumatic fever as a child can cause scarring on the heart’s valves. Rheumatic fever most often results from untreated strep throat or other streptococcal infections, mainly in children ages 5 to 15. Thanks to antibiotics, such infections can be treated before RF develops. “People who have rheumatic fever as a kid may end up in their 20s or 30s having rheumatic heart disease,” explains Dr. Vivek. The disease results from RF scarring, causing narrowing and stiffening of the affected valve. Frequently, that’s the mitral valve, but Dr. Vivek says it can impact any valve.

Fallout From Bacterial Infections
Bacterial infections like infective endocarditis (IE) can also damage heart valves. When bacteria enter your bloodstream and attach to one or more of your valves, growths form that can prevent a valve from fully closing, causing blood to leak back through the valve from which it came rather than flowing forward. IE can also destroy valve tissue, creating additional leaks. Cardiologist Glenn Hirsch, M.D., of National Jewish Health in Denver, says injecting illicit drugs ups your odds of IE because of bacteria found on dirty needles.

The Importance of Oral Health
One effective way to lower your risk of HVD: Keep your teeth clean. “It’s amazing how many bacteria live in our mouths,” says Dr. Vivek. Oral hygiene basics like brushing, flossing, and regular dental care can help prevent IE. And never ignore toothaches, tooth sensitivity to heat or cold, or other potential signs of a tooth infection. “That can seed your bloodstream with bacteria,” he adds, explaining how doctors check for dental infections before doing valve replacement surgery. “The last thing we want is to put a new valve in and have it get infected because of a dental infection.”

High Blood Pressure and Valve Injury
Another risk factor for HVD: high blood pressure (HBP). “Injury to the valves can occur due to stress placed on the valves by high blood pressure,” says Dr. Hirsch. When you have high blood pressure, he explains, your heart has to work harder to keep up with your body’s demands. Over time this can lead to thickening and enlarging of the heart, which in turn may make it difficult for your mitral valve to close completely—leading to mitral valve regurgitation (which often comes with aging, too). HBP also contributes to narrowing of the aortic valve, or aortic stenosis.

Previous Heart Attack Ups HVD Risk
If you’ve already had a heart attack, you may be more likely to develop a heart valve problem. According to Dr. Hirsch, the heart’s lower left chamber, the left ventricle, may dilate, or become enlarged, after a heart attack. When this occurs the ventricle pulls the papillary muscles, which control the mitral valve, until the valve cannot close properly, causing blood to leak into the left upper chamber (the left atrium).This forces the heart to work harder to pump blood and can lead to heart failure. “It’s not actually a valve disorder,” notes Dr. Hirsch. “But it affects the valves.”

Diabetes and HVD
Poorly managed diabetes also ups your odds of developing HVD. Dr. Hirsch says there’s a link between high blood sugar levels and hardening of the valves. Diabetes also increases your chances of other major risk factors for this condition—not only are you twice as likely to have HBP, your odds of a heart attack are about six times greater than someone who does not have diabetes. Diabetes is the number-one cause of kidney disease, which causes your heart’s valves to calcify, or stiffen, says Dr. Hirsch. “Having good control of diabetes is important,” he adds.

Lower HVD Risk With Healthy Living
Can you reduce your risk of HVD? Yes, says Dr. Hirsch, in large part by living a heart-healthy lifestyle. “It’s about lowering your risk of heart disease by treating your cardiovascular risk factors,” he explains. That means keeping your blood pressure and cholesterol under control, which you can usually do by eating a diet that helps your heart, engaging in regular exercise, and, if your doctor recommends it, taking heart medications. Dr. Hirsch specifically recommends the Mediterranean diet, which favours poultry and fish over red meat and promotes fruits, vegetables, whole grains, and healthy fats (like olive oil).

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