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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.