Response to Letter Regarding Article, “Familial Clustering of Mitral Valve Prolapse in the Community”

We thank Dr Barison and colleagues for their interest in our article. In our manuscript, we demonstrate that both parental mitral valve prolapse (MVP) and parental mild, nondiagnostic MVP are associated with increased prevalence of MVP in the offspring in the Framingham Heart Study community. In their letter, Barison et al underline the importance of age when assessing MVP prevalence, stating that MVP is more common among older participants in the offspring or generation 2 (Gen 2) than in the younger generation 3 (Gen 3). Based on published Framingham Heart Study literature, 2 the prevalence of MVP in Gen 2 is 2.4% at their fifth examination cycle. This percentage is slightly higher in the same cohort at their sixth examination cycle (98/3380 or 2.9%) and at their eighth examination cycle (94/2725 or 3.4%; ie, 11 to 17 years after the fifth examination). In addition, in the younger Gen 3 (average age of 40 years at their first examination cycle) the prevalence of MVP is 1.4% (56/4061) and lower than in Gen 2 (average 55-67 years of age at their sixth and eight examination cycles, respectively). Of note, the proportion 49 of 3679 or 1.3% reported in our article is not the prevalence of MVP among all Gen 3 participants, but only that among those with available parental information. Overall, these findings are consistent with an age-related increase in the prevalence of MVP. In addition, reevaluation of MVP status at follow-up examination cycles of Gen 3 may help confirm these initial observations.