Gender differences in the epidemiology of Rheumatic Fever/Rheumatic heart disease (RF/RHD) patient population of hill state of northern India; 9 years prospective hospital based, HP-RHD registry

Abstract

Objectives We report the gender-based differences in the prevalence, severity, pattern of valvular involvement, and complications in patients with Rheumatic Fever/Rheumatic heart disease (RF/RHD). Methods The 2475 consecutive patients with RF/RHD diagnosed using clinical and echocardiographic criteria were registered prospectively from January 2011 till December 2019. The association of gender with the pattern of valvular involvement, nature, and severity of valvular dysfunction and cardiovascular complications was analyzed using a logistic regression model, and odds ratios with 95% CI were estimated. Results The mitral and tricuspid valve involvement was significantly lower in the male gender, odds ratio with 95% CI of 0.55 (0.44–0.61), and 0.69 (0.58–0.83) respectively, while the aortic valve was affected more frequently than females, odds ratio 1.36 (1.14–1.62). The severity of valvular disease had no significant association with gender, 0.99 (0.82–1.20). The association between gender and cardiovascular complications, heart failure, stroke, and atrial fibrillations were not statistically significant. The prevalence of RF/RHD was more than two-fold higher in female gender than male (71.4% vs. 29.6%, p < 0.0001). Conclusions RF/RHD is more prevalent in females. Gender has a significant association with the pattern of valvular involvement. The severity of valvular dysfunction and cardiovascular complications had no significant association with gender.

Subjective wellbeing among rheumatic heart disease patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: observational cross-sectional study

“…Higher autoimmunity with effect of sex hormones and better RHD detection during antenatal care in the reproductive age women were postulated reasons for higher RHD occurrence in females. More severe valvular lesions were also documented among females [ 27 ]. Social factor like child raising which increases ARF/RHD susceptibility are also incriminated as plausible explanation [ 28 ].…”

Epidemiologic Profile of Patients With Valvular Heart Disease in Korea: A Nationwide Hospital-Based Registry Study

“…Women have a higher prevalence of MS than men, with a ratio of 3:1; the prevalence of rheumatic VHD is also higher in women than in men. 24) This can be explained by the differences in endogenous hormones, which are the key mediators of rheumatic disease progression. 25) Furthermore, women providing childcare would have higher exposure to Streptococcus pyogenes .…”

Sub-clinical rheumatic heart disease (RHD) detected by hand-held echocardiogram in children participating in a school-based RHD prevention program in Tanzania

“…This finding is similar to many previous studies [ 9 – 11 , 13 , 14 , 35 ]. The reasons of higher RHD among females are not well understood [ 35 – 37 ], although it is generally known that most of autoimmune diseases affect females more than males [ 38 ]. A recent study has however shed light on the possible reasons for female predominance in RHD, implicating Prothymosin alpha as a potential regulator of sex predisposition in RHD [ 39 ].…”