Introduction:
The risk factors for development of rheumatic heart disease (RHD) are well described for highrisk countries but less well known for low-risk countries, including Ukraine.

Aim of the study:
The aim of this study was to investigate the role of demographic, social, and medical risk factors for development of RHD in a low-risk area (Western Ukraine) with an annual incidence of acute rheumatic fever (ARF) of 1 per 100,000 population.

Material and methods:
Between 2007–2014, 132 subjects aged 8–17 years from three medical centres were enrolled in the study. Of them, 78 patients developed RHD either after ARF (n = 48, 61.5%) or subclinically (n = 30, 38.5%) and were selected as cases. The remaining 54 subjects, who had ARF but did not develop RHD during follow-up, were defined as controls. The median follow-up period of subjects after ARF was five years (range 3–10 years). Demographic, social and medical factors were linked to development of RHD by univariate and multivariable regression modelling.

Results:
At the univariate level, rural population and unemployed parents were found to be at significantly higher risk of development of RHD. Among medical risk factors, chronic infections, recurrent ARF, and lack or irregularity of secondary prevention were found to be significant determinants of RHD. In multivariable analysis, living in a rural area (OR = 6.85, 95% CI = 2.39–19.67), recurrent ARF (OR = 37.18, 95% CI = 4.21–328.34), and lack of secondary prevention of ARF (OR = 4.10, 95% CI = 1.04–16.14) were found to be significant predictors for development of RHD.

Conclusions:
The present study has shown that in a low-risk population, living in a rural area, recurrent ARF, and lack of secondary prevention independently predict the development of RHD.