We recommend that research on valve disease span the spectrum from basic science to prospective randomized trials, includ- ing medical therapy, and that studies focus on each stage of the disease process, from the patient at risk to the patient with end-stage disease. Newer approaches, such as artificial intelligence and machine learning, as well as imaging and engineering advances, may pro- vide sophisticated tools for diagnosis and therapeutics. Research should be patient centered, with patients in- cluded at every stage of the research process to ensure that questions and outcomes important to patients are included in the study design, implementation, and re- porting. 16.1. Prevention of Valve Disease: Stage A On a worldwide basis, rheumatic fever remains the pri- mary cause of VHD; global health systems outcomes studies are needed to identify impediments to success- ful primary and secondary prevention of rheumatic heart disease. Other approaches to prevention, such as vaccine development, and delaying disease progres- sion once valve damage is present should also be ex- plored. Disease prevention in patients at risk of other types of valve disease is needed, including the control of known cardiovascular risk factors. Some subgroups at risk of calcific AS can be identified, such as those with a congenital BAV or elevated lipoprotein(a) lev- els. However, there are no known therapies to pre- vent valve dysfunction in these patients. Basic science studies on the genetic and pathobiological causes of valve dysfunction will provide insight into mechanisms of disease that might allow identification of patients at risk and allow early intervention to prevent disease CLINICAL STATEMENTS AND GUIDELINES 16.2. Medical Therapy to Treat or Prevent Disease Progression: Stage B In patients with early VHD, including those with cal- cific or myxomatous disease, there are currently no therapies to prevent disease progression in the valve leaflets. 