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TITLE: A STUDY OF RHEUMATOID FACTOR AND ITS RELATION TO ISCHEMIC HEART DISEASE ABSTRACT: INTRODUCTION : Ischemic heart disease (IHD) is a leading cause of death in the world. Most of the subjects with IHD may have traditional risk factors including diabetes,smoking, hypertension,obesity. Rheumatoid Factor (RF) has been associated with an increased likelihood of developing IHD.Presence of RF in general population may identify the subjects with a similar immune pathology to patients with RA, who may also share an increased likelihood of developing IHD and that RF may have special role in the pathogenisis of IHD . MATERIALS AND METHODS: Cross sectional observational study done from April 2021 to August 2021 in Kamineni institute of medical sciences Narketpally, included 50 patients, who were all RF positive.During the study period they were evaluated for IHD by E CG and ECHO.Those who are included in the study were evaluated for traditional risk factors h/o Diabetes, smoking,family h/o IHD and hypertension,BMI for Obesity and features of RA. A resting 12 lead ECG was carried out for features of IHD.The following ch anges in the ECG were taken as marker of ischemia: 1)The combination of ST elevation in a set of leads and reciprocal ST depression in a set of leads.2) Inversion of T with ST still being elevated.3) Presence of pathological Q waves RESULTS : Of the 5 0 patients with RF positivity, there were 32 (64 %) females and 18 (36%) males.Ischemic changes in ECG in presence of RF with traditional risk factor is n=6 (75%) M 4(50%) F-- 2(25%) and RF without traditional risk factor is n=2 (25%) M2(25%) F0.In the present study there were 8 patients who had RF positivity with Ischemic changes in ECG. 6 were males and 2 were females. DISCUSSION : In the study population, most of the RF positive patients clustered between 3050 years. Dividing the study population with ischemic changes by ECG, by age, 6% were below 40 years and 10% were above 40 years. All of the above patients had RF positivity along with traditional risk factors and ischemic changes in the ECG. In this study 3 6 wer e females. % were males and 6 4 % Comparatively females were more common in present study population. This is because the patients selected were suffering RA which is more common in females. Considering the ischemic changes, males were affected more than females though more nu mber of female patients were included in the study. Evaluating the 16%(n= positive with Ischemic changes 6 8 ) who were RF patients had traditional risk factors. The other 2 patients had only RF positivity without any other risk factor. All these 2 patients were males. This indicates an association of RF and IHD a strong possibility especially in males. This study has a number of potential limitations. The most important fact is that this is a cross-sectional study and will need confirmation by a longitudinal cohort study. CONCLUSIONS: • RF per se can be considered as one of the risk factor for Ischemic heart disease in males. • RF associated with traditional risk factors increase the prevalence of IHD. • Though more female patients have positive RF, they are not vulnerable to IHD. REFERENCES: 1) Peters MJ, Symmons DP, McCarey D, et al. EULAR evidencebased recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010;69:325–331. [PubMed] [Google Scholar] 2) Peters MJ, van Halm VP, Voskuyl AE, et al. Does rheumatoid arthritis equal diabetes mellitus as an independent risk factor for cardiovascular disease? A prospective study. Arthritis Rheum. 2009;61:1571–1579. [PubMed] [Google Scholar] 3) Francis ML, Varghese JJ, Mathew JM, Koneru S, Scaife SL, Zahnd WE. Outcomes in patients with rheumatoid a rthritis and myocardial infarction. Am J Med. 2010;123:922 [Google Scholar]928. [PubMed] 4) Bacani AK, Gabriel SE, Crowson CS, Heit JA, Matteson EL. Noncardiac vascular disease in rheumatoid arthritis: increase in venous thromboembolic events? Ar 2012;64:53thritis Rheum. 61. [PMC free article] [PubMed] [Google Scholar]5) Zoller B, Li X, Sundquist J, Sundquist K. Risk of subsequent ischemic and hemorrhagic stroke in patients hospitalized for immune mediated diseases: a nationwide followup study f rom Sweden. BMC Neurol. 2012;12:41. [PMC free article] [PubMed] [Google Scholar] 6)Nielen M M,vanschaardenberg D,Reesink H W,et al . Specific autoantibodies precede the symptoms of rheumatoid arthritis:a study of serial measurements in blood donors.Arth ritis Rheum 2004;50:3806.
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