12 3
1
WITH TRADITIONL RISK FACTORS
RF-HIGH TITRE
RF-LOW TITRE
Lone RF without traditional risk factors was seen in only 4 male patients.there were no female patient .Of the 4 male patients 3 had high titre RF (>350).
In men
4/35 ==11.495%
CONFIDENCE INTERVEL= 4 – 28
χ2YATES CORRECTED P=0.01 SIGNIFICANT In study population
4/100== 4%
CONFIDENCE INTERVEL= is 1.7-5.4.
χ2YATES CORRECTED P=0.01 SIGNIFICANT
DISCUSSION In the study population, most of the RF positive patients clustered between
30-50 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 35% were males and 65% were females. The M:F ratio was 1:
1.8. 16 patients had ischemic changes in ECG constituting 11males (31.1%) and 5 females (7.7%)patients. This is concordant with Edwards C J et al1 where the M:F ratio was 1 : 1.02 . 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 number of female patients were included in the study. This is also similar to Edwards C J et al1
Evaluating the 16%(n=16) who were RF positive with Ischemic changes 12 patients had traditional risk factors(75%).The other 4 patients had only RF positivity without any other risk factor. All these 4 patients were males. This indicates an association of RF and IHD a strong possibility especially in males.
Among the 11male patients who had RF positivity with traditional risk factors and ischemic changes, 6 patients had high titre of RF and 5 patients had
low titre. Percentage wise 37.5% and 31.25% were having high and low titres of RF along with traditional risk factors causing IHD. This is concordant with both Edwards C J et al1, Kenneth J Warrington et al4.
Among the 5female patients who had RF positivity with traditional risk factors , 2 patients had ischemic changes with high titre of RF making up 12.5%.
3 patients had ischemic changes with low titre RF and traditional risk factors forming 18.75% This is disconcordant with both Edwards C J et al1, Kenneth J Warrington et al4.
By these data we can conclude, RF with traditional risk factor have increased incidence of ischemic changes in males than females especially high titre RF.
In this study only 4 patients had RF positivity without traditional risk factors along with ischemic changes and all of them were males.This is 36.3% of the total RF positive males in study population and 11.495% total male patients.
No female patients had lone RF without traditional risk factor. This study is in concordance with Edwards C J et al1
The long term Herfordshire Cohort study reported by Sydall H E et al5 had similar results. RF positive male patients without traditional risk factors are vulnerable to IHD. Females with traditional risk factors did not have IHD – this is discordant with this study. Our study indicated that IHD may be associated with
RF and traditional risk factors in females which is as in the study of Sydall H E et al5
Of these 4 male patients, 3 patients had high titre of RF positivity which is 75% and one patient had low titre of RF which is 25% .This suggested that a high titre of RF may have an increased incidence of IHD. This concurs with the earlier study by Edwards C J et al1 and del Puente A et al3
In this study, Autoantibody RF which is risk factor for IHD in men is 11.495% (4 out of 35); confidence interval(CI) is 4-28 and 4% (4out of 100) study population; This goes with many other similar studies from various parts of the world.
Most of the of the studies state the prevalence to be between 4-28%.
Edwards C J et al1- 11.6%( in men), Kenneth J Warrington1 et al4 -1.97% (in general population).
From the observation and analysis of study assumed that there is an association between high titre of RF and IHD.This association was significantly more in male patients.
This study has a number of potential limitations. The most important is the fact that this is a cross-sectional study and will need confirmation by a longitudinal cohort study.
CONCLUSIONS
¾ RF per se can be considered as one of the risk factor for Ischemic heart disease in males.
¾ High titre RF alone can further increase the Incidence of IHD.
¾ RF associated with traditional risk factors increase the prevalence of IHD.
¾ Though more female patients have positive RF ,they are not vulnerable to IHD
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PROFORMA
Name:
Age:
Sex:
OP No.
Address:
Presenting Complaints:- H/o HT
H/o Diabetes Mellitus H/o IHD
H/o Smoking Family H/o IHD Rhematalogical H/O EXAMINATION:
Pulse:
BP:
CVS:
RS:
P/A:
CNS:
INVESTIGATIONS: