Cardiovascular risk factors in adult general out-patient clinics in Nigeria: a country analysis of the Africa and Middle East Cardiovascular Epidemiological (ACE) study.

Abstract

BackgroundWith globalization and rapid urbanization, demographic and epidemiologic transitions have become important determinants for the emergence of cardiovascular disease (CVD).ObjectiveTo estimate the prevalence of CVD risk factors in adult out-patients attending general practice and non-specialist clinics in urban and rural Nigeria.MethodsAs part of the Africa and Middle East Cardiovascular Epidemiological (ACE) study, a cross-sectional epidemiologic study was undertaken for the presence of hypertension, diabetes mellitus, dyslipidemia, obesity, smoking and abdominal obesity in Nigeria.ResultsIn total, 303 subjects from 8 out-patient general practice clinics were studied, 184 (60.7%) were female and 119 (39.3%) were male. Mean age was 42.7±13.1 years; 51.8% were aged <45 years; 4% ≥65 years. Over 90% of subjects had ≥1 of 6 selected modifiable cardiovascular risk factors: 138 (45.6%) had 1–2; 65 (21.5%) had 3; 60 (19.8%) had 4; and 11 (3.6%) had 5 concurrent risk factors. Screening identified 206 subjects (68.0%) with dyslipidemia who did not have a prior diagnosis.ConclusionCardiovascular risk factors are highly prevalent in Nigerian subjects attending out-patient clinics. Moreover, many subjects were undiagnosed and therefore unaware of their cardiovascular risk status. Opportunistic screening alongside intensive national, multisectoral education or risk factor education is needed, should be scaled up nationwide and rolled out in both urban and rural communities in Nigeria.

Selected Cardiometabolic Risk-factor Clusters of Urban Hypertensive Adults in Response to 72-hour ABU Radio Frequency Modulated (F.M.) Call for Free-medical Screening

“…34 The high prevalence of CMRFC in the present study however doubly exceeds report by the African and Middle East Cardiovascular and Epidemiological study done in several general outpatient clinics across Nigeria. 6 The reason for this disparity may be the targeted cohort of hypertensive subjects aged above 30 years presenting from urban areas in this study as against the subject selection of patients with varied disease conditions and age groups recruited from primary health care facilities of both rural and urban areas in the latter study. It also contrasts previous reports of low prevalence of metabolic syndrome in sub-Saharan Africa.…”

“…Urbanization has been linked with sedentary lifestyle and physical inactivity associated with advancement in technology, consequently leading to central obesity, insulin resistance, diabetes and or hypertension. [4][5][6]20,24,42 It has also been associated with nutritional transition to poor low fibre, refined sugary, high salt/cholesterol and energy-rich diets devoid of fruits and vegetables, consequently resulting in increased adiposity and thus cardiometabolic risks. [4][5][6][7]10,20 The findings here is of importance for public health intervention policies as it suggests that people of urban incline in the Northern region of the country have multiple risk factors for cardiometabolic disease and adverse cardiovascular outcome as against the previous thinking.…”

“…4,5 Additionally, there is demographic transition associated with progressively ageing population in countries like Nigeria as well as epidemiologic transition as the battle against communicable diseases is competing with the rising burden of noncommunicable diseases like diabetes, hypertension and CVD's. 6,7 Consequently, the emergence of these cardiometabolic risk factors and its attendant increased morbidity and mortality is a cause for alarm as it poses significant health-care burden in Nigeria. 6 More so, hypertensive population are particularly vulnerable to cardiometabolic risk hence optimal reduction of such risk is imminent.…”

“…6,7 Consequently, the emergence of these cardiometabolic risk factors and its attendant increased morbidity and mortality is a cause for alarm as it poses significant health-care burden in Nigeria. 6 More so, hypertensive population are particularly vulnerable to cardiometabolic risk hence optimal reduction of such risk is imminent. 8 Hypertension is a major risk factor for arteriosclerotic cardiovascular diseases affecting one billion people globally as at the year 2000 with projection of 1.56 billion by 2025.…”

“…14,18 Systematic studies incorporating random risk profile screening programs in health care facilities in both rural and urban Nigerian communities were initiated to encourage healthier lifestyle of which the Africa and Middle East Cardiovascular Epidemiological Study (ACE) is one of such. 6 Furthermore, there are few studies emanating from Northern part of the country on cardiometabolic risk profile assessment in hypertensive subjects 19,20 with previous reports from the Southern part of the country [21][22][23] as well as meta-analysis and reports cutting across the geopolitical zones of Nigeria. 6,24 This study was therefore aimed at determining the prevalence of selected cardiometabolic risk among hypertensive adults who responded to a 72 hr radio FM call for free medical attention and cardiovascular screening at Zaria, Nigeria and to evaluate its association with hypertension.…”