Heterogeneous geographic distribution of patients with aortic valve stenosis: arguments for new aetiological hypothesis.

C alcific aortic valve stenosis is by far the most common valve disease in developed countries. The first clinical symptoms usually appear in the late 60s. Prosthetic aortic valve replacement is the only effective treatment at present. The reasons for the occurrence of calcifications of the aortic cusps leading eventually after many years to aortic valve stenosis are unknown. Some risk factors, mainly those already recognised in vascular disease, have been found to be associated with aortic valve stenosis and are considered to cause the disease. 4 However, these factors are totally nonspecific and may be confounded with factors leading to other illnesses. Recently a genetic hypothesis has been proposed after observation of a few familial cases but remains largely challenged in the absence of gene determination. The aim of our study was to evaluate whether epidemiological data collected in a selected region of France could provide evidence in favour of this hypothesis.