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Purpose: Non-dipping status is associated with increased total and cardiovascular mortality in many disease conditions including diabetes mellitus. The pattern and its implications are not well described among Africans. This study was done to describe the frequency of abnormal blood pressure (BP) dipping among T2DM subjects, its determinants and correlates in Ogbomoso, Nigeria. Methods: This was a cross-sectional study done at the LAUTECH Teaching Hospital, Ogbomoso. One hundred individuals diagnosed with T2DM were recruited and they had 24-hour ambulatory BP monitoring, echocardiography, ECG, and carotid Doppler among other evaluations. Statistical analysis was done using SPSS 27.0 (Chicago Ill, USA). Results: The mean age of the participants was 59.3 ± 10.8 years, mean body mass index 27.7 ± 5.9 kg/m2 with a mean duration of diabetes of 7.52 ± 5.54 years. Abnormal BP dipping was present in 89% (consisting of 41% or reverse dippers and 48% non-dippers). T2DM subjects with abnormal dipping pattern were more likely to be females, had higher glycated haemoglobin, lower fractional shortening, higher left atrial volume and left ventricular mass index, and a higher DM duration than those with normal BP dipping status. The major determinants of abnormal dipping pattern were the duration of diabetes and low HDL-C concentration. Conclusion: Abnormal BP dipping pattern is highly prevalent in T2DM subjects, especially among females. Abnormal BP dipping was also associated with markers of increased cardiovascular risk such as impaired kidney function, left ventricular hypertrophy, postural hypotension, history of intermittent claudication, and presence of plaques on carotid Doppler studies. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases have become the leading cause of premature morbidity and mortality worldwide, with 80% originating from developing countries. The prevalence of cardiovascular risk factors is on the increase, especially in the developing nations of the world. There are limited data on the burden of cardiovascular disease risk factors among a cohort of educated public servants in Abakaliki, Nigeria. Objectives: To determine the prevalence and pattern of selected cardiovascular risk factors among a cohort of public servants in Abakaliki, Nigeria. Methodology: This is a cross-sectional descriptive study where a cohort of public servants was screened for the presence of selected cardiovascular risk factors during their annual t meeting at Abakaliki, Nigeria on the 16th of December 2022. They were made up of males and females of working-class age and they all possessed a minimum educational attainment of a university degree (≥17 years of formal education). Results: Out of the 120 participants screened, cardiovascular disease risk factors were present in 66 persons (55%) (male- 35.8%, female19.2%) and were more preponderant among older participants. Overweight (27.5%), and hypertension (25.8%) were the most prevalent risk factors identified. The mean age, heart rate, systolic blood pressure, and fasting blood glucose were significantly higher in male participants while the mean body mass index was significantly higher in their female counterparts. The majority (40.8%) of the participants had a single risk factor while few others had multiple risk factors. Conclusion: Cardiovascular disease risk factors are prevalent among a cohort of public servants in Abakaliki, Nigeria with a preponderance of overweight and hypertension. [ABSTRACT FROM AUTHOR]

Obesity is associated with cardiovascular disease (CVD) risk and type 2 diabetes mellitus (T2DM). Apolipoprotein (APO) C3 C3238G and C1100T gene polymorphisms are risk factors for CVD but their relationship with obesity and T2DM in Black Africans has not been fully elucidated. Association of these gene polymorphisms with hypertension and dyslipidemia among obese type 2 diabetics in a Southwest Nigerian population was assessed.One hundred and thirty-eight (138) non-obese diabetics, 107 obese diabetics, 100 obese non-diabetics and 100 control subjects attending metabolic clinic in Osun State Nigeria were enrolled. Anthropometric parameters were measured. Fasting blood sugar (FBS), lipid profile and APOC3 protein were estimated using standard lab procedures. APOC3 gene polymorphisms were analyzed by polymerase chain reaction - restriction fragment length polymorphism. Data were analyzed and significant level set at p<0.05. APOC3238G G allele was associated with higher risk of hypertension (OR=2.39, 95%CI=1.03-5.53; p=0.042) in obese diabetics compared to other groups. Highest frequency for hypertension was observed among obese diabetics expressing CC than CG and GG genotypes. GG genotype was associated with dyslipidemia in obese diabetic subjects exhibiting APO C3 C3238G single nucleotide polymorphism (SNP). Homozygous CC genotype showed highest frequency (χ2: 25.515, p<0.05) than other genotypes and was associated with increased atherogenic indices among obese diabetic subjects expressing APO C3 C1100T SNP. APOC3 C1100T gene and polymorphic alleles of the G variant of APOC3 C3238G gene were associated with dyslipidemia and hypertension in obese T2DM individuals, thereby contributing to increased risk of CVD among the studied population. [ABSTRACT FROM AUTHOR]

Background: Gene–environment interactions play a major role in the phenotypic expression of complex disease traits such as those for cardiovascular diseases. Aims: This study aimed to determine the gene–environment interactions that underpin the relationship between interleukin‑10 (IL‑10) single‑nucleotide polymorphism (1082 G/A[rs1800896]) with lifestyle on cardiovascular disease risk in adult Nigerians with type 2 diabetes mellitus(DM). Setting and Design: This case–control study involved patients with type 2 DM with high cardiovascular risk, determined by the Framingham’s classification, and age, sex, and diabetes‑duration matched subjects with low and intermediate cardiovascular risks. Subjects and Methods: The genotypes were detected by polymerase chain reaction (PCR) followed by allelic discrimination using the Applied Biosystems 7900HT Fast Real‑Time PCR System. One‑way analysis of variance and logistic regression were employed for analysis. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated to estimate the risk caused by the polymorphism. P <0.05 was considered significant. Results: The odds for cardiovascular risk decreased progressively in individuals with the GG, GA, and AA genotypes (OR = 0.80, 95% CI = 0.49–1.28, P = 0.345 and OR = 0.46, 95% CI = 0.24–0.88, P = 0.018 for GA and AA genotypes, respectively. A significantly higher proportion of homozygous (AA) individuals were in the low cardiovascular risk group (54.2%, P = 0.018). Compared with the whole study population, individuals with the AA genotype had consistently lower odds for cardiovascular risk in subpopulations like alcohol users (OR = 0.25 [0.11–0.55], P = 0.001), but the odds were higher among smokers (OR = 1.80 [1.14–2.90], P = 0.017) and those with sedentary lifestyles (OR = 2.46, 95% CI = 1.14–5.33, P = 0.024). Conclusions: The homozygous mutant genotype AA of the IL‑10 gene 1082 G/A had a protective effect on cardiovascular risk in type 2 DM. However, this protection was absent in those leading a sedentary lifestyle. [ABSTRACT FROM AUTHOR]

Introduction: The burden of cardiovascular disease (CVD) is huge due to its associated morbidity, mortality and adverse socio-economic impact. Environmental pollution as a risk factor contributes significantly to the burden of CVD, especially in the low and middle income countries. One of the effective strategies to reduce CVD burden is to prevent or detect cardiovascular risk factors early in at-risk population. This study determined some cardiovascular risk factors, kidney function, and their association with heavy metals among automobile mechanics. Method: This was a cross-sectional study involving 162 automobile mechanics and 81 age and sex matched controls. Serum levels of lead, cadmium and some cardiovascular risks were assessed and compared in the two groups. Associations between serum lead, cadmium and some cardiovascular risks were determined using correlation analysis. P value of <0.05 was taken as significant. Results: The mean ages of the automobile mechanics and controls were 47.27±9.99 years and 48.94±10.34 years, respectively. The prevalence of elevated serum cadmium was significantly higher in the automobile mechanics (25.9% vs 7.9%; p = <0.001). The significant cardiovascular risk factors in the automobile mechanics vs controls were elevated total cholesterol (32.1% vs 18.5%; p = 0.017), hyperuricemia (20.4% vs 1.2%; p = <0.001), elevated blood glucose (16.0% vs 4.9% p = 0.013); and alcohol use (55.1% vs 30.0%; p = 0.001). Among the automobile mechanics, there were significant positive correlations between serum cadmium, atherogenic index of plasma (AIP) (p = 0.024; r = 0.382) and triglyceride (p = 0.020; r = 0.391). Significant positive correlation was found between serum lead and neutrophil gelatinase associated lipocalin (NGAL) (p = <0.001; r = 0.329). There were significant positive correlation between serum cadmium level, AIP (p = 0.016; r = 0.373) and TG (p = 0.004; r = 0.439); between serum lead and NGAL in all the study participants (p = 0.005; r = 0.206). Conclusion: Automobile mechanics have notable exposure to heavy metals and a higher prevalence of some cardiovascular risk factors. Health education and sensitisation as well as policies that would regulate exposure of persons to heavy metals should be implemented in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Neurological disorders constitute major causes of morbidity, and globally, they are the leading causes of death. There is a dearth of neurologists in most African countries and the very few available ones are concentrated in urban areas. The cardiovascular and communicable risk factors responsible for most cases of acute and chronic neurological disorders are also prevalent in rural areas. Although patients from the neighbouring states attend the study centre, the majority are indigent. Therefore, there is a need to observe the pattern of these disorders in Ekiti, to appreciate the disease burden as it would help in the judicious allocation of human and other healthcare resources. Methodology: We reviewed the case files of patients seen at the neurology clinic and admitted via the emergency department into the Federal Teaching Hospital, Ido-Ekiti, over a period of 6 years (2016 to 2021). Results: A total of 881patients were seen during the study period, and they were mostly elderly male patients with chronic disorders in which stroke was the most common neurological disorder (44.9%) followed by seizure disorder (13.1%), and neurodegenerative disorders (9.9%). Tumors and myopathies were the least seen disorders. Conclusion: Health literacy on cardiovascular risk factors and even the distribution of manpower and material resources will help reduce the burden of neurological disorders among the attendees of the Ekiti tertiary health institution. [ABSTRACT FROM AUTHOR]

The burden of cardiovascular disease (CVD) has been on the rise in developing countries like Nigeria recently. Studies on perceived CVD risk and the risk status of adults in Ibadan are not readily available, hence this study. A mixed-method design involving a cross-sectional survey and an exploratory qualitative study was utilized. Convenience sampling was used to recruit 418 participants (209 from rural and 209 from urban) for the cross-sectional survey, while purposive sampling was used to recruit 14 participants for the qualitative aspect. The INTERHEART risk score and the Perception of Risk of Heart Disease Scale were used to investigate participants' CVD risk status and perceived risk, respectively. The data from the cross-sectional survey were summarized by using descriptive statistics, and the data were then analyzed by using the chi-square test of association and a multiple logistic regression model, while content thematic analysis was used to analyze the qualitative data. In the rural and urban area s, respectively, 39.7% and 52.2% had a positive perception of CVD risk. In the rural and urban areas, 44% and 41.6% of individuals respectively had moderate-to-high risk of CVD. Participants with at least secondary school education [2.66 (0.61-11.53)] and participants in the urban area [2.62 (0.78-7.08)] had twice higher odds of positive CVD risk perception. Males [3.91 (1.58-9.68)], adults aged 40 and above [1.59 (0.63-4.00)] and urban dwellers [1.21 (0.33-4.39)] had higher odds of a high CVD risk status. The qualitative aspect of the study corroborated the findings from the survey, as many participants did not perceive themselves as being at risk of CVD. The majority of the participants in this study were found to have a moderate-to-high risk of CVD, and many had a negative perception of their risk. Health education and CVD prevention programs are required to curb the burden of CVD. [ABSTRACT FROM AUTHOR]

Background: In Sub-Saharan Africa (SSA), the prevalence of hypertension is increasing due to many factors like rapid population growth, globalization, stress, and urbanization. We aimed to characterize the perceptions of cardiovascular disease (CVD) risk among individuals with hypertension living in Nigeria and identify barriers and facilitators to optimal hypertension management. Methods: This cross-sectional survey study was conducted at a large teaching hospital in Lagos, Nigeria. We used a convenient sample of males and females, aged 18 or older, with a diagnosis of hypertension who presented for outpatient visits in the cardiology, nephrology, or family medicine clinics between November 1 and 30, 2020. A semiquantitative approach was utilized with a survey consisting of closed and open-ended questionnaires focused on patient knowledge, perceptions of CVD risk, and barriers and facilitators of behavioral modifications to reduce CVD risk. Results: There were 256 subjects, and 62% were female. The mean age was 58.3 years (standard deviation (SD) = 12.6). The mean duration of the hypertension diagnosis was 10.1 years. Most participants were quite knowledgeable about hypertension; however, we observed some knowledge gaps, including a belief that too much "worrying or overthinking" was a major cause of hypertension and that an absence of symptoms indicated that hypertension was under control. Barriers to hypertension management include age, discomfort or pain, and lack of time as barriers to exercise. Tasteless meals and having to cook for multiple household members were barriers to decreasing salt intake. Cost and difficulty obtaining medications were barriers to medication adherence. Primary facilitators were family support or encouragement and incorporating lifestyle modifications into daily routines. Conclusion: We identified knowledge gaps about hypertension and CVD among our study population. These gaps enable opportunities to develop targeted interventions by healthcare providers, healthcare systems, and local governments. Our findings also help in the promotion of community-based interventions that address barriers to hypertension control and promote community and family involvement in hypertension management in these settings. [ABSTRACT FROM AUTHOR]

Diabetes is associated with a high degree of cardiovascular morbidity and mortality. The co-existence of other cardiovascular risk factors alongside diabetes confers the cumulative risk of adverse outcomes. The prevalence of cardiovascular risk factors has been rising in sub-Saharan Africa, but their degree of co-existence with diabetes is not well known. The objective of this study was to determine the burden of cardiovascular risk factors in patients with Type 2 Diabetes Mellitus (T2DM) in a urban southeastern Nigerian population. This was a cross-sectional study consisting of consecutively recruited diabetic patients aged ≥40 years attending the diabetes clinic at Enugu State University of Science and Technology Teaching Hospital (ESUTH). Five cardiovascular risk factors were evaluated: Hypertension, overweight/obesity, cigarette smoking, physical inactivity, and poor glycemic control We studied 410 T2DM patients (31.5% male) with a mean age of 58.9 years and a mean duration of diabetes of 7.4 years. The most prevalent cardiovascular risk factor in the study was physical inactivity (69.5%), and 80.1% of respondents had 2 or more risk factors. Females had a significantly higher prevalence of physical inactivity, overweight/obesity, and poor glycemic control when compared to males (73% vs 62%; 73.3% vs 58.9%; 72.2% vs 60.5%, respectively). Our study has shown a high burden of cardiovascular risk factors in diabetic patients in an urban southeastern Nigerian population. Female diabetic subjects had a significantly higher prevalence of most of the cardiovascular risk factors except for smoking. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is the leading cause of death in the United States (U.S.). Immigrant groups from sub-Saharan Africa in the U.S. have higher CVD risk than their African American counterparts. This study examines associations of sociodemographic factors (age, sex, education, & income) to acculturation, cultural beliefs, and CVD risk levels (CVDRL) among Nigerian, Ghanaian, and Cameroonian immigrants (NGCI) in the U.S. A correlational cross-sectional design was used. Data from a convenience sample (n = 178) of NGCI were analyzed using correlations, regressions, and path analysis. Acculturation had a statistically significant influence on cultural beliefs (β = 0.16, P <.05). Age, sex, and education were the strongest predictors of CVDRL among the NGCI sample. High acculturation among NGCI in the U.S. have been associated with more health-promoting cultural beliefs. It is important that NGCI who may have difficulties understanding the culture of the U.S. healthcare system receive quality care. [ABSTRACT FROM AUTHOR]

Background: Studies have linked ABO phenotypes to cardiovascular diseases (CVDs); however, data on the relationship between ABO phenotypes and CDV risk factors among healthy adults are lacking. Aim: To determine the relationship between ABO phenotypes and CVD risk factors among undergraduate students in Kano, Nigeria. Materials and Methods: This cross-sectional descriptive study recruited 150 participants. ABO phenotypes were determined using monoclonal antisera. Serum total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterolwere determined enzymatically, while low-density lipoprotein cholesterol (LDL-c) was calculated using the Friedewald equation. Blood pressure and anthropometric measurements were by standard protocols. Data were analyzed using SPSS version 23.0; P ≤ 0.05 was considered statistically significant. Results: Mean age of the participants was 23.12 ± 2.97 (17–31) years. The frequency of ABO phenotypes among the participants was: O (39.3%), B (26.0%), A (23.3%), and AB (11.3%). Non-O phenotypes had significantly lower systolic blood pressure (P = 0.050), higher TC (P = 0.023), TG (P = 0.003), and LDL-c (P = 0.050) compared to O phenotypes. Of the non-O phenotypes, A had significantly higher TC compared to B (P = 0.004) and O (P = 0.001); higher TG compared to O (P = 0.001); higher LDL-c compared to B (P = 0.001), AB (P = 0.042), and O (P = 0.006); heavier compared to B (P = 0.012) and O (P = 0.033); and higher hip circumference compared to B (P = 0.022). Conclusion: Non-O phenotypes, especially A phenotypes, had significantly higher mean serum lipids compared to O. ABO phenotypes should be considered in CVD risk stratification. [ABSTRACT FROM AUTHOR]

Objectives: To determine if there is any association between combined oral contraceptives (COCs) use and blood pressure (BP) change, dyslipidaemia and cardiovascular risks among COCs’ users. Design: A descriptive cohort study among 162 acceptors of COCs recruited consecutively from 2016-2020. Setting: Family planning unit of Olabisi Onabanjo University Teaching Hospital, Sagamu, Southwest, Nigeria. Subjects: Consented women who met the inclusion criteria and took up COCs as a form of family planning within the study period. Intervention: All the subjects were placed on Levofem DKT brand of combined oral contraceptive pill (levonorgestrel 0.15mg, ethinylestradiol 0.03mg, ferrous fumarate 75mg) at a dose of one tablet daily. Their blood samples were taken for fasting lipid profile (FLP) and their BP measured both at recruitment and at six months of follow-up. Outcome measures: Change in the FLP and BP within the six months of use of the COC. Data analysis was done using SPSS version 26 by IBM incorporation. Level of significance was set at P<0.05. Results: The mean age of our participants was 29.53±4.92 years. There was statistically significant association between COCs use and mean change in Total Cholesterol (t =5.263, P=0.001,), Triglyceride (t =24.974, P=0.001), Low density lipoprotein (4.974, P=0.001), high density lipoprotein (t=12.790, P=0.001) as well as the Castelli index 1 and 2 (t= 12.439, P=0.001, t=10.910, P= 0.001). However, there was no relationship between mean change in FLP and BP. Conclusion: COCs use was associated with dyslipidaemia and indirectly with cardiovascular risks. It showed no significant association with BP change. [ABSTRACT FROM AUTHOR]

Background/Aim: Kidney dysfunction is an established risk factor for cardiovascular diseases including stroke. The study aimed at assessing the frequency of kidney dysfunction in patients with acute stroke and to evaluate the relationship to the type, severity and outcome of stroke. To establish a relationship, which has not been explained in past studies. Materials and Methods: This was a cross-sectional analytical study on acute stroke patients and matched controls, evaluating for kidney dysfunction using both estimated glomerular filtration rate (GFR) and the spot urine protein creatinine ratio. The type of stroke was observed by neuroimaging. The National Institute of Health Stroke Score was used to assess the severity of stroke at presentation and outcome after 7 days. Data analysis was done using Statistical Package for Social Sciences (SPSS) application version 23.0 (SPSS Inc., Chicago, IL, USA). Results: Ninety-eight patients and 100 controls were recruited, with a mean age of 64.7 ± 15.5 and 64.8 ± 15.1 years, respectively. The patients with stroke had a statistically significant higher frequency of kidney dysfunction compared to the controls (85.9% vs. 62.0%, P = 0.001). Patients with haemorrhagic stroke had a higher frequency of kidney dysfunction compared with those with ischaemic stroke (93.8% vs. 77.3%, P = 0.048). The proportion of patients with kidney dysfunction was seen to increase from those with mild to those with severe stroke symptoms, both at presentation and after 7 days. Estimated GFR was seen to be an independent predictor of poor outcome in patients with stroke (odds ratio 0.955, 95% confidence interval 0.924 - 0.986, P = 0.005). Conclusion: The study demonstrated that in patients with acute stroke there is a high frequency of kidney dysfunction. Haemorrhagic stroke, increasing stroke severity and poor outcome were seen to be associated with kidney dysfunction. Thus, recommending the need for kidney care as an important part of stroke management. [ABSTRACT FROM AUTHOR]

Elevated waist circumference results from an excessive accumulation of visceral fat, causing an impairment of health. Waist circumference is highly correlated with diabetes, cardiovascular disease, and all-cause mortality. This study aimed to estimate the overall, sex-specific, and region-specific prevalence rates of central obesity in Nigeria. Systematic review and meta-analysis. Online searches of Google Scholar, PubMed, and Scopus were conducted, and studies were selected based on predefined criteria. Random effects model was fitted using inverse variance method with correction using Sidik-Jonkman's estimator. Eighteen studies consisting of 21,859 individuals conducted between 1996 and 2021 were included in the meta-analysis. Thirty-nine percent (95% confidence interval [CI]: 25%–54%, I2 = 99.3%) of adult Nigerians are centrally obese (by International Diabetes Federation criteria). This translates to estimated 46.8 million centrally obese adult Nigerians. More than half (54% [95% CI: 39%–68%]) of adult females are centrally obese. This is four times the prevalence in males (13% [95% CI: 5%–24%]). Southern regions have higher prevalence of central obesity than northern regions (48% vs 18%). The overall mean waist circumference in Nigeria is 83.8 cm (95% CI: 80.8–86.8 cm, I2 = 99.8%, P value is <0.001). Females, urban residents, and individuals living in the northern part of Nigeria have a high burden of central obesity. Public health measures for halting the epidemic of obesity should be targeted at these high-risk groups. [ABSTRACT FROM AUTHOR]

Introduction: This study evaluated the status of stage 2 hypertension, abnormal ECG and their co-occurrence as possible risk factors of cardiovascular disease and their predictors in a Nigerian University population. Methods: A total of 717 subjects participated in this study. Blood pressure (BP), resting electrocardiogram (ECG) and other clinical parameters were measured and categorised according to standard organisational guidelines. Bivariate correlation and multivariate logistic regression model were used to determine covariates and clinical parameter association at a 95 % significant level. Results: Stage 2 hypertension and abnormal ECG respectively occurred in 264 (37 %) and 217 (39.2 %) subjects, with co-occurrence and abnormal BMI in 85 (11.8 %) and 459 (64.8%) subjects, respectively. Sex (p = 0.001) and occupation (p = 0.022) were independently associated with abnormal BP and ECG, respectively, while age was independently associated (p < 0.001) with abnormal BP, ECG and co-occurrence of these conditions. Predictors of stage 2 hypertension and abnormal ECG were sex (adjusted odds ratio [aOR] = 1.652, 95 % CI 1.097–2.488) and occupation (aOR = 0.411, 95 % CI 0.217–0.779), respectively, while age was a predictor for stage 2 hypertension (aOR = 0.065, 95 % CI 0.015–0.283), abnormal ECG (aOR = 0.137, 95 % CI 0.053–0.351) and their co-occurrence (aOR = 0.039, 95 % CI 0.014–0.113). Conclusions: This study shows prevalence rates of these risk factors are on the increase. It also suggests that ECG abnormality is a public health issue among stage 2 hypertensive patients that must be monitored. Therefore, appropriate interventions that prevent and control hypertension and identified risk factors should be put in place in addition to lifestyle changes, regular screening and surveillance. [ABSTRACT FROM AUTHOR]

Introduction: metabolic syndrome portends an increased risk of cardiovascular events and death. Evidence showed that healthcare workers are at higher risk of cardiovascular events because of their engagement in night-shift work. Therefore, this study determined the association between metabolic syndrome and healthcare work status in Ekiti State, Nigeria. Methods: this was a crosssectional study involving 105 healthcare workers and 143 non-healthcare workers. The diagnosis of metabolic syndrome was made based on the International Diabetic Federation criteria: abdominal obesity plus, any two of: elevated blood pressure ≥ 130/85 mmHg or previous diagnosis of hypertension on the use of antihypertensive medications; impaired fasting glucose; elevated triglycerides; and low HDL-cholesterol. Factors associated with metabolic syndrome were analysed using univariable and multivariable analysis. Results: men comprised 37.9% of the study population and the mean age was 42.1 ± 9.7 years. The prevalence of metabolic syndrome was similar in both groups (HCWs-29.5% vs non-HCWs- 28.0%, p-value=0.789); overall prevalence was 28.6%. Abdominal obesity, elevated total cholesterol and elevated LDL-cholesterol occurred more frequently in HCWs than in non-HCWs: (68.6% vs 55.2%, pvalue= 0.034; 65.7% vs 39.2%, p-value= < 0.001 and 50.5 vs 28.7%; p-value < 0.001) respectively. Female sex (aOR: 3.67, 95% CI: 1.74-7.45; p < 0.001) and obesity (aOR: 4.39, 95% CI: 2.31-8.37; p < 0.001) were associated with metabolic syndrome. Conclusion: a similar prevalence of metabolic syndrome was observed in the healthcare workers and the non- healthcare workers. However, abdominal obesity, elevated total cholesterol and elevated LDL-cholesterol occurred more frequently in healthcare workers than in non- healthcare workers. [ABSTRACT FROM AUTHOR]

Introduction: dyslipidemia and hypertension are independent cardiovascular risk factors that are linked by insulin resistance and commonly coexist as components of the metabolic syndrome. The consequences of dyslipidaemic patterns includes high cardiovascular risk profile and sequalae. Data on lipid patterns amongst hypertensive patients in Abuja, a city with affluent pattern of life style and rising cardiovascular risk profile is very scanty or limited to just levels of total plasma cholesterol. This study was aimed at determining the pattern and frequencies of dyslipidaemic forms among hypertensive patients in Abuja. Methods: this was a retrospective cohort study with the following data collected; socio-demographics, anthropometric measures and certain metabolic parameters from the new and old groups and analyzed using IBM SPSS Statistics, version 23. All decisions were made using the assymp. Two-sided Pearson χ2 probability. Quantitative variables were expressed as means and standard deviations. Qualitative variables were expressed as percentages. A p-value of ≤0.05 was set as significant. Results: eight hundred and fifty eight (858) cases were enrolled for this study, 704 (82.1%) olds and 154 (17.9%) news. There were 251 (29.3%) males and 607 (70.7%) females. The means of the two groups were largely comparable. The commonest dyslipidaemic type was reduced High density lipoprotein, HDL (96.1%), followed by elevated low-density lipoprotein, LDL (78.6%), then, elevated total cholesterol, (62.3%) TCHOL and elevated triglycerides, TG 43.5%. Conclusion: dyslipidemic forms are very common among hypertensive patients in Abuja, Nigeria, particularly reduced HDL. Some observed associations include; middle age, female gender, middle/upper socio-economic classes, low levels of physical activity, overweight/obesity, dysglycaemia and long-standing hypertension. [ABSTRACT FROM AUTHOR]

Spontaneous intracerebral hemorrhage (ICH) is associated with a high case fatality rate in resource-limited settings. The independent predictors of poor outcome after ICH in sub-Saharan Africa remains to be characterized in large epidemiological studies. We aimed to determine factors associated with 30-day fatality among West African patients with ICH. The Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study conducted at 15 sites in Nigeria and Ghana. Adults aged ≥18 years with spontaneous ICH confirmed with neuroimaging. Demographic, cardiovascular risk factors, clinical features and neuroimaging markers of severity were assessed. The independent risk factors for 30-day mortality were determined using a multivariate logistic regression analysis with an adjusted odds ratio (OR) and 95% confidence interval (CI). Among 964 patients with ICH, 590 (61.2%) were males with a mean age (SD) of 54.3(13.6) years and a case fatality of 34.3%. Factors associated with 30-day mortality among ICH patients include: Elevated mean National Institute of Health Stroke Scale(mNIHSS);(OR 1.06; 95% CI 1.02–1.11), aspiration pneumonitis; (OR 7.17; 95% CI 2.82–18.24), ICH volume > 30mls; OR 2.68; 95% CI 1.02–7.00)) low consumption of leafy vegetables (OR 0.36; 95% CI 0.15–0.85). This study identified risk and protective factors associated with 30-day mortality among West Africans with spontaneous ICH. These factors should be further investigated in other populations in Africa to enable the development of ICH mortality predictions models among indigenous Africans. • A prospective multicentre, case-control study in patients with spontaneous intracerebral hemorrhage in Nigeria and Ghana. • Intracerebral hemorrhage is associated with high case fatality. • Low GCS, large hematoma volume, and aspiration pneumonitis are associated with 30-day mortality. • Cardiac disease, intraventricular hemorrhage, pyrexia and origin of the hemorrhage were not associated with mortality. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is a global problem but its increasing prevalence in the working age group in developing countries like Nigeria is concerning and needs urgent attention. Methods: The study was a mixed method design: quantitative phase with 402 participants and qualitative phase with 16 participants in two focus groups. The participants in the quantitative survey phase completed two questionnaires on the knowledge and perception of CVD and its risk factors. Data from the quantitative cross-sectional survey were analysed using descriptive and inferential statistics. The qualitative data were analysed using content thematic analysis. Results: We report that 39.1% of the participants had high knowledge whilst 61.9% had low and average knowledge of CVD and its risk factors. Of the participants, 78.1% had a wrong perception of CVD and its risk factors. Participants from faculties of veterinary medicine and basic medical sciences had better knowledge than others who were not medically inclined (F = 16.11; p < 0.001). Only participants from the faculty of veterinary medicine had the right perception of CVD and its risk factors. There was no significant difference in knowledge and perception scores between male and female participants. The qualitative study buttressed the results from the cross-sectional survey, where adolescents and young adults highlighted academic stress and poverty as major risk factors for CVD. Conclusion: Adolescents and young adults in this study did not have good knowledge of CVD and its risk factors. They also had a wrong perception about CVD and its risk factors. [ABSTRACT FROM AUTHOR]

Background Early identification and treatment of cardiovascular disease (CVD) risk factors through screening are crucial in the primary prevention of CVD and reduction in healthcare-related costs. Use of Non-Physician Healthcare-workers including Community Pharmacists has been advocated as an effective and cost-efficient model of healthcare delivery. In Nigeria the use of community pharmacists for mass screening of CVD risk factors has not been explored. Objective We sought to investigate the possibility of mass CVD risk factor screening in community pharmacies by pharmacists. Setting Lagos, Nigeria. Methods Between October and December 2018 eight hundred and eighty-nine apparently healthy participants were screened for obesity, hypertension, diabetes and hypercholesterolaemia in ten community pharmacies. Diabetes and hypercholesterolaemia were screened for using point-of-care testing modalities. A structured questionnaire was used to obtain the socio-demographic data of the participants. Main outcome measures Prevalence of overweight/obesity, hypertension, diabetes, hypercholesterolaemia, smoking and alcohol intake. Results Mean age of the subjects was 56.8 ± 21.1 years. Majority (57.4%) were females. Prevalence of smoking and alcohol intake were 4.3% and 26.7% respectively. 59.7% and 71.5% of males and females were either overweight (BMI ≥ 25 kg/m2) or obese (BMI ≥ 30 kg/m2) respectively. Prevalence of hypertension was 28.2% in all subjects, 30.9% in males and 26.3% in females, p < 0.001. Using BP > 130/80 mmHg prevalence of hypertension was 55.1%. Diabetes was detected in 3% of the subjects while 45.3% had hypercholesterolaemia. In total, 64.1% of the subjects were diagnosed with CVD risk factors for the first time. Conclusion Opportunistic screening for CVD risk factors is possible in community pharmacies and has the ability to detect previously undiagnosed risk factors. This community pharmacy based model could serve as a cost-effective approach to primary prevention of CVD. [ABSTRACT FROM AUTHOR]

Background: The prevalence of hypertension in Nigeria is high and growing. The burden and risk factor distribution also vary by geographical zone. Information about prevalence, risk factors and disease status awareness are needed to guide evidence based public health response at the national and sub- national levels. Purpose: This paper describes the prevalence of hypertension and its correlates, as well as hypertension status awareness among men in North Central, Nigeria. Methods: A cross sectional survey was administered to male partners of pregnant women participating in the Healthy Beginning Initiative program from 2016–2018. Information on socio-demographic characteristics, risk factors, physical measurement and blood pressure readings were collected using a standardized protocol. Data was analyzed with simple and multiple logistic regression. Results: The 6,538 men had a median age of 31 years [IQR: 26–37]. The prevalence of hypertension was 23.3% (95% CI: 22.3%-24.4%), while 46.7% had prehypertension. The odds of hypertension was associated with increasing age (OR:1.02, CI:1.01–1.03), being overweight (aOR:1.5,CI:1.3–1.8), being obese (aOR:2.6,CI:2.0–3.3), living in an urban area (aOR:1.6,CI:1.2–2.1), and alcohol use in the 30 days prior (aOR:1.2,CI:1.1–1.4). Overall, 4.5% (297/6,528) of participants had ever been told they have hypertension. Among the 23.3% (1,527/6,528) with hypertension, 7.1% (109/1,527) were aware of their disease status. Men aged 41–50 years (aOR: 1.8, CI: 1.0–3.3), and > 50 years (aOR: 2.2, CI: 1.1–4.3), had higher odds disease status awareness. Living in an urban area was associated with lower odds (aOR: 0.2, CI: 0.03–0.7) of hypertension status awareness. Conclusion: This study showed that hypertension is already a significant public health burden in this population and that disease awareness level is very low. Alcohol use and obesity were associated with hypertension, highlighting some modifiable cardiovascular disease risk factors that are prevalent in the study population. Taken together, these findings can inform the design of interventions for primary and secondary cardiovascular disease prevention in Nigeria and similar settings. [ABSTRACT FROM AUTHOR]

Leprosy reduces quality of life of affected persons. Oxidative stress caused by reactive oxygen species may play a vital role in the pathogenesis of leprosy. This study evaluated anthropometric indices, fasting plasma glucose (FPG), lipid profile, total antioxidant capacity (TAC), total plasma peroxide (TPP), oxidative stress index (OSI), malondialdehyde (MDA), glutathione (GSH) and 8-hydroxy-2-deoxyguanosine (8-OHdg) in leprosy patients. Sixty test participants of both genders, aged 18–65years and diagnosed of multibacillary leprosy and 30 apparently healthy controls were consecutively recruited for this study. The test participants comprised of 30 patients on multidrug therapy (MDT) and 30 patients relieved from therapy (RFT). Body mass index (BMI), Waist-hip ratio (WHR), FPG, lipid profile, TAC, TPP, OSI, MDA, GSH and 8-OHdg were determined using appropriate methods. Data were analyzed using Analysis of variance; p<0.05 was considered statistically significant. The MDT group had significantly lower BMI (p = 0.0001), Total cholesterol (p = 0.001), HDL-C (p = 0.019), LDL-C (p = 0.005), TAC (p = 0.0001) and higher TPP (p = 0.001), MDA (p = 0.0001), OSI (p = 0.005) and 8-OHdg (p = 0.035) compared to the controls. The RFT group had significantly lower BMI (p = 0.001) Total cholesterol (0.0001), HDL-C (p = 0.006) LDL-C (p = 0.0001), TAC (p = 0.001) and higher WHR (p = 0.010), VLDL-C (p = 0.035), TG (p = 0.023) Atherogenic index of plasma (p = 0.0001) and TPP (p = 0.001), MDA (p = 0.0001) compared to the control group. GSH levels correlated negatively with duration of treatment (r = -0.401, p = 0.028). This study has shown that there is oxidative stress in multibacillary leprosy patients irrespective of drug treatment status. This study also shows that leprosy patients relieved from treatment may be susceptible to cardiovascular events. Antioxidants supplementation may be beneficial in the treatment of leprosy and clinical follow up on patients relieved from treatment may also be necessary to monitor health status and prevent development of cardiovascular events. Author summary: This study shows that there are lower levels of total antioxidant capacity and higher levels of total plasma peroxide, malondialdehyde in leprosy patients undergoing multidrug therapy and those relieved from treatment and higher levels of 8-OHdg and oxidative stress index in leprosy patients undergoing multidrug therapy. This is suggestive of increased oxidative stress, in multibacillary leprosy patients irrespective of drug treatment status and increased oxidative DNA damage in those undergoing multidrug therapy. Antioxidants supplementation may be beneficial in the treatment of leprosy to protect against the effects of oxidative stress and DNA damage. Leprosy patients relieved from treatment may be susceptible to cardiovascular events as shown by higher levels of VLDL-cholesterol, triglycerides and atherogenic index of plasma observed in that group compared to controls. It therefore points to the need to monitor cardiovascular comorbidities in patients on multidrug therapy and those released from therapy. [ABSTRACT FROM AUTHOR]

Background: Commercial motor vehicle drivers (CMVDs) have worst health profiles among different occupations, yet the presence of clusters of cardiovascular disease (CVD) risk factors in this group have not been described in a resource-limited setting. Objectives: The prevalence of CVD risk factors and the clusters among CMVDs was evaluated. Design: A cross-sectional descriptive study. Setting: Four motor parks in three local government areas of Ibadan city, Nigeria. Participants: Consented and conveniently sampled 152 intra-city CMVDs aged ≥ 18 years. Main outcome measures: Prevalence of CVD risk factors (hypertension, diabetes, high triglyceride, low HDLc, high waist-hip ratio, central obesity, physical inactivity, smoking, alcohol, and overweight/obesity) and their clusters were determined. Results: All participants were male from 20 – 77 years old. Most of the CMVDs were physically inactive (80, 52.6%), take alcohol (78, 51.3%), and few smokes (35, 12.4%). The prevalence of hypertension, diabetes, hypertriglyceridemia, obesity, and central obesity were 36.2%, 5.9%, 23.7%, 4.6%, and 5.3%, respectively. Four clusters of CVD risk factors in the CMVDs with the prevalence of 36.2%. 33.5%, 17.1% and 13.2% were identified with significant differences (p<0.05) in the risk factors. Conclusion: The prevalence of diabetes, obesity, central obesity, and smoking was low while the prevalence of hypertension and hypertriglyceridemia was moderate among the CMVDs, but the prevalence of alcohol intake and physical inactivity were high. Four distinct clusters of CVD risk factors were observed among the drivers. [ABSTRACT FROM AUTHOR]

This study set out to identify the unhealthy lifestyle habits adopted by nurses at the University College Hospital (UCH), Ibadan which could predispose to Cardiovascular diseases (CVDs) and assess the cardiovascular risk factors among them. A cross sectional study design was utilized. The study population consisted of nurses working on the wards at the UCH, Ibadan who were between the ages of 30-60 years. Systematic random sampling was adopted in selecting 196 nurses for this study. A structured questionnaire was administered to consenting nurses. Focus group discussions were conducted to further probe into the details of the questionnaire. 94.9% of respondents were female and the mean age of respondents was 39.3±7.4 years. About 32% of the respondents engaged in moderate exercise less than once a week, 59% of the respondents slept between 5-6 hours at night, 44.9% ate fried food 1-2 times weekly, 42.9% consumed one or more litres of soda drink per week. Majority demonstrated high level of awareness about cardiovascular risk factors such as cigarette smoking (78.1%), alcohol use (76.5%), overweight/obese (75.5%), high blood cholesterol (73.5%), physical inactivity (71.9%) and diabetes mellitus (70.9%). However, there was a low level of awareness about cardiovascular risk factors such as race (41.3%) and gender (34.2%). A significantly higher proportion (70%) of respondents who ate fried foods on an average of 3-6 times per week were overweight/obese (p=0.016). Obesity was also associated with family history of cardiovascular diseases (p=0.04). The focus group discussions highlighted nurses' views about difficulties in practicing known healthy lifestyle habits. The study highlighted a moderate prevalence of cardiovascular risk factors such as obesity, consumption of fried foods and physical inactivity among nurses. Efforts should be directed towards the promotion of healthy lifestyles among nurses. [ABSTRACT FROM AUTHOR]

Cigarette smoking has been linked to atherosclerosis, coronary artery disease, peripheral vascular disorders and various malignancies. However, the mechanism by which smoking increases the risk of cardiovascular diseases is still controversial. One hundred and forty one apparently healthy male cigarette smokers and sixty apparently healthy non-smokers aged 18 to 65 years were enrolled into the study. The smokers were sub-divided into light (<8 pack years), moderate (8-30 pack years) and heavy (>30 pack years) smokers. Anthropometric indices and blood pressure were measured. Fasting plasma glucose, total cholesterol (TC), triglycerides and High density lipoprotein-cholesterol (HDL-C) were estimated using colorimetric test methods while low density lipoproteincholesterol (LDL-C) and very low density lipoprotein were calculated using Friedewald's equation. Serum insulin was estimated using ELISA. Data was analyzed using SPSS version 20.0; level of significance was set at p<0.05. The smokers had significantly higher diastolic BP (p=0.0001), TC (p= 0.008) and LDL-C (p = 0.0001) and significantly lower HDL-C (p = 0.0001) compared to the non-smokers. There was a significant higher fasting plasma glucose in the light smokers (p=0.001) than in the moderate and heavy smokers whereas, serum TC and LDL-C levels were significantly increased in heavy smokers (p=0.001) than in the light and moderate smokers. There was a negative correlation between BMI and smoking pack years. Dyslipidaemia was observed to be the most prevalent cardiovascular disease risk factor. It is concluded that the alterations in lipid profile and blood pressure observed in this study may contribute to higher risk of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus increases the risk of cardiovascular diseases and all-cause mortality. The present study investigated the effect of an eight-week aerobics programme on fasting blood sugar (FBS), cardiovascular parameters, peripheral oxygen saturation (SpO2), and body mass index (BMI) among subjects with type-2 diabetes mellitus (T2DM). Methods: A pretest-posttest experimental design was employed. Fifty subjects, diagnosed with T2DM, attending the Diabetes Clinic of the University of Nigeria Teaching Hospital, Enugu, were conveniently recruited, gender and age-matched, and randomised into exercise and control groups. The intervention included an eight-week aerobic exercise at 6o%--79% HRmax for 45 min-- 60 min, 3-days per week. The FBS, SpO2, BMI, resting heart rate (RHR), and systolic (SBP) and diastolic blood pressure (DBP) of the subjects were measured before and after the intervention. The paired and independent t-test(s) were used for the analyses within and between the groups, respectively (P ≤ 0.05). Results: The exercise group had a significantly lower SBP (15.0 mmHg, P = 0.001), DBP (7.9 mmHg, P = 0.001), RHR (4.8 bpm, P = 0.001), FBS (34.9 mg/dl, P = 0.001), and BMI (2.3, P = 0.001), while the SpO2 improved by 3.9% with P = 0.001, relative to the control group. Conclusion: Aerobics is an efficacious adjunct therapy in controlling the FBS level, blood pressure, BMI, and improving SpO2 among T2DM subjects. [ABSTRACT FROM AUTHOR]

Background Studies in international literature have shown that Community Pharmacists can make considerable impact in controlling cardiovascular disease risk factors, especially hypertension. In Nigeria, there are no studies on the knowledge of CVD risk factors by Community Pharmacists and their practice of primary prevention. Objective To assess the knowledge of CVD risk factors and practice of primary prevention of CVD amongst Nigerian community pharmacists. Setting Community Pharmacists in Lagos, Nigeria. Methods This cross-sectional study involved 168 Community Pharmacists. Their knowledge of CVD risk factors was assessed with the Heart Disease Fact Questionnaire. Their opportunistic screening practices for CVD risk factors (primary prevention) were also assessed. Main outcome measures Knowledge of CVD risk factors and practice of primary CVD prevention. Results The mean age of the participating pharmacists was 41.7 (± 11.2) years and 87 (51.8%) of them were males. The median number of years of practice was 9.0 (3-15) years. Mean knowledge score was 22.1 (± 3.0) with 154 (91.7%) of the subjects scoring above 70%. An average of 95.5% of the participants correctly identified hypertension, smoking, dyslipidaemia, obesity, physical inactivity and diabetes as CVD risk factors. Eighty-one (48.2%) had good practice of primary CVD prevention. Conclusion: This study shows that Community Pharmacists in Nigeria have very good knowledge level of CVD risk factors and almost 50% of them practised primary prevention of CVD. [ABSTRACT FROM AUTHOR]

The burden of hypertension, a silent killer, continues to increase in low- and middle-income countries. This study evaluated blood pressure (BP) in healthy adults to determine their risk of developing hypertension and to reduce associated morbidity of the disease. Overall, 182 subjects aged >16 years participated in the study. Systolic (SBP) and diastolic blood pressure (DBP) was measured after a resting period using mercury sphygmomanometer. Random blood glucose (RBG) concentration was also determined. Regression models were used to determine risk of high BP with p values < 0.05 indicating statistical difference. Prehypertension was present in 36.8% population and high BP in 31% individuals with hypertensive symptoms. DBP ≥ 90 mmHg was prevalent in the undiagnosed group, while diabetes comorbidity was detected in only 4 individuals. High BP or diabetes was not detected in those <20 year olds. Age > 35 years was an independent risk (likelihood ratio: 22.56, p<0.0001); this increases to 26.48 (p<0.0001) in the presence prediabetes and RBG > 100 mg/dl. Undiagnosed hypertension rate is high in the study area, and urgent interventions for large scale screening and management of the disease are required to reduce the burden of hypertension in Nigeria. [ABSTRACT FROM AUTHOR]

Background Among high-risk individuals, statins are beneficial for primary prevention of cardiovascular disease (CVD). In Nigeria, currently, there are no CVD prevention guidelines, so the use of CVD risk estimation to guide statin therapy is left to the discretion of the physician. Objective The objective of the study was to compare 3 CVD risk estimation tools in the evaluation of patients presenting to a tertiary hospital in Nigeria. Methods Cross-sectional study involving 295 patients with any CVD risk factors but not taking statins. Traditional CVD risk factors were assessed with a standard questionnaire and laboratory evaluation. Ten-year CVD risk was estimated with American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ACC/AHA ASCVD) Risk Estimator (2013), Framingham Risk Score (Framingham Risk Score [FRS] 2008), and the World Health Organisation/International Society of Hypertension (WHO/ISH) risk prediction chart for Africa Region D. Kappa statistic was used to determine agreement among the estimators. Results The mean age was 48.4 ± 10.4 years; 60.7% were females. Risk factors for CVD were hypertension (56.3%), dyslipidemia (41.4%), diabetes (20%), obesity (28.5%), and cigarette smoking (4.4%). In all, 50.2%, 16.9%, and 15.2% were classified as high risk using the ACC/AHA ASCVD Risk Estimator, FRS 2008, and WHO/ISH risk chart, respectively. The agreement was moderate between FRS and WHO/ISH (Kappa 0.414, P < .001) and fair between ACC/AHA Estimator and WHO/ISH (Kappa 0.223, P < .001) and between ACC/AHA Estimator and FRS (Kappa 0.301, P < .001). Conclusions The considerable variation in prediction of high risk using the 3 tools may lead to underutilization of evidence-based therapy. This underscores the dire need for the development of risk prediction tools derived from our own Nigerian population. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a risk factor for cardiovascular diseases (CVDs) and there are reports of increasing prevalence of prediabetes in Nigeria. This study therefore characterised CVDs risk factors in subjects with impaired fasting glucose (IFG) and diabetes.Methods: Data from 4 population-based cross-sectional studies on 2447 apparently healthy individuals from 18 - 89 years were analysed. Anthropometric, blood pressure and biochemical parameters were collected and classified. Individuals with IFG (prediabetes) and diabetes were merged each for positive cases of dyslipidaemia, high blood pressure (HBP) or obesity. Optimal Discriminant and Hierarchical Optimal Classification Tree Analysis (HO-CTA) were employed.Results: Overall prevalence of IFG and diabetes were 5.8% (CI: 4.9 - 6.7%) and 3.1% (CI: 2.4 - 3.8%), respectively. IFG co-morbidity with dyslipidaemia (5.0%; CI: 4.1 - 5.8%) was the highest followed by overweight/obese (3.1%; CI: 2.5 - 3.8%) and HBP (1.8%; CI: 1.3 - 2.4%). The predicted age of IFG or diabetes and their co-morbidity with other CVD risk factors were between 40 - 45 years. Elevated blood level of total cholesterol was the most predictive co-morbid risk factor among IFG and diabetes subjects. Hypertriglyceridaemia was an important risk factor among IFG-normocholesterolaemic-overweight/obese individuals.Conclusion: The higher prevalence of co-morbidity of CVD risk factors with IFG than in diabetes plus the similar age of co-morbidity between IFG and diabetes highlights the need for risk assessment models for prediabetes and education of individuals at risk about factors that mitigate development of diabetes and CVDs. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is a public health concern worldwide. Hypertensive heart disease is predominant in Nigeria. To effectively reduce CVD in Nigeria, the prevalence of, and factors associated with, pre-hypertension in Nigerian youth first need to be established.Methods: A locally-validated CVD risk factor survey was completed by 15-18 year olds in a rural setting in south-west Nigeria. Body Mass Index (BMI), waist-hip ratio and systolic and diastolic blood pressure was measured. Putative risk factors were tested in gender-specific hypothesized causal pathways for overweight/obesity, and for pre-hypertension.Results: Of 1079 participants, prevalence of systolic pre-hypertension was 33.2 %, diastolic pre-hypertension prevalence approximated 5 %, and hypertension occurred in less than 10 % sample. There were no gender differences in prevalence of pre- hypertension, and significant predictors of systolic pre-hypertension (high BMI and older age) were identified. Considering high BMI, older age was a risk for both genders, whilst fried food preference was female-only risk, and low breakfast cereal intake was a male-only risk.Conclusion: Rural Nigerian adolescents are at-risk of future CVD because of lifestyle factors, and high prevalence of systolic pre-hypertension. Relevant interventions can now be proposed to reduce BMI and thus ameliorate future rural adult Nigerian CVD. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is an immense global problem with serious economic and social consequences. Modifiable risk factors for CVD have been identified internationally in adolescents where early intervention programs have the potential to reduce CVD risk on individual and population levels. In developing countries such as Nigeria, little is known about the prevalence of modifiable CVD risk factors among adolescents especially in the rural areas. Methods: This paper reports on a cross-sectional survey of modifiable CVD risk factors among rural adolescents in South-West Nigeria. All 15-18 years old adolescents in all the schools at Ibarapa central local government were approached and all those who assented and consented to participate in the study were involved. A total of 1500 adolescents participated in the study. Measurements of CVD risks factors taken were; smoking, physical activity, alcohol, dietary pattern using a questionnaire developed by authors. Other CVD risk factors such as waist hip ratio and BMI were taken using standardized instruments. Data were analyzed using STATA version 12. Results: Data from 1079 adolescents (56.5 % males and 53.5 % females) were analyzed. Mean age of males was 16.4 ± 1.14 years and mean age for females was 16.29 ± 1.13 years. Adolescents showed clustering of CVD risk factors with about 72 % having between two and four risk factors. A total of 102 clustering patterns were reported. The most common clustering pattern (19.6 %) included high animal lipid and salt diet. Conclusion: There is high level and clustering of CVD risk factors among rural adolescents in Southwest Nigeria. The most common clustering pattern was biased towards dietary factors. The high prevalence of CVD risk factors among rural adolescents in Southwest Nigeria suggests that urgent primary prevention programs are required to prevent the next generation of Nigerians from suffering of CVD. [ABSTRACT FROM AUTHOR]

Background: Poor adherence to antihypertensive medications has been linked with increased cardiovascular risk and mortality in many population. Africans have been shown to have a worse prognosis from hypertension, poorer blood pressure control, and increased risk of complications arising from hypertension compared to Caucasians. Aim: The aim was to describe the level of adherence to antihypertensive medications, its determinants and whether any difference exist between those attending specialty clinic or general outpatient department (GOPD) Clinic in a Nigerian University Teaching Hospital. Subjects and Methods: An analytical cross-sectional study. The Morisky scale was used to assess for adherence to antihypertensive medications. Clinical and demographic data were taken. Statistical analysis was performed using SPSS 17.0. (Chicago, IL, USA). P < 0.05 was taken as statistically significant. Results: A total of 114 hypertensive subjects were recruited for this study. Seventy-nine were from the cardiology clinic whereas 35 were from the GOPD. They consisted of 60 males (52.6%, 60/114) and 54 females (47.4%, 54/110). The mean age was 63.6 (14.1) years. High adherence, low adherence and medium adherence as defined by Morisky scale was found in 36.8% (42/114), 23.9% (27/114) and 39.5% (45/114), respectively. Adherence level was higher among those attending specialty clinic despite shorter duration of hypertension and use of more medications. More than four-fifth of those attending cardiology clinic had at least medium level of adherence compared to a little bit over half of those attending GOPD clinic. Those with good adherence were likely to be older, had a higher level of education and higher average monthly income than those with poor adherence. Conclusion: Poor adherence to medications is very common in the hypertensive Nigerians. Hypertensive subjects attending specialty clinic seems to have a better adherence to antihypertensive medications possibly due to the level of health education and information provided to patients. Effective health education and regular screening for compliance and adherence is a potential way to reduce cardiovascular risk associated with uncontrolled hypertension. [ABSTRACT FROM AUTHOR]

Introduction. Death from coronary artery disease (CAD) has been until recently considered rare in Nigeria. We present a report of a study of CAD with its predisposing cardiovascular (CVD) risk factors in South South Nigeria. Methods. We examined the autopsy reports of 747 coroner cases and 41 consecutive clinically diagnosed cases of ischemic heart disease seen in South South Nigeria. Results. CAD was diagnosed in 13 (1.6%) of747 autopsies. They were predominantly males, urban residents, and of high social class with combination of CVD risk factors of hypertension, alcohol use, diabetes mellitus, cigarette smoking, poor physical activities, and obesity. The mean serum cholesterol of the clinical subjects was 4.7 ± 1.57 mmol/L and 5.07 ± 1.94 mmol/L for angina and myocardial infarction, respectively, which was higher than the mean total cholesterol for locality of 3.1 mmol/L. Conclusion. CAD and its risk factors are contributing to mortality and morbidity in South South Nigeria. These risk factors include hypertension, alcohol use, diabetes mellitus, cigarette smoking, poorphysical activity, and obesity. Nigerians inthislocalitywith CADhave raised serum lipids. [ABSTRACT FROM AUTHOR]

Background: We explored the relationship between anthropometric indices (obesity and abdominal adiposity) and the presence of an atherogenic lipid profile in Nigerians with major cardiovascular risk factors (type 2 diabetes mellitus-T2DM, hypertension-HBP, and concomitant disease). Materials and Methods: Using a prospective design, 278 patients with T2DM, HBP, or concomitant disease, attending out-patient diabetes and hypertension clinics at a tertiary institution in Nigeria were evaluated. All patients were cholesterol-lowering oral medication naïve. Demographic and clinical data and anthropometric measurements were documented. Fasting lipid profiles were measured in all cases. The cut-off points for defining dyslipidaemia were: Elevated total cholesterol (TC) (mg/dL) ⩾200, elevated low-density lipoprotein cholestrol (LDL-C) (mg/dL) ⩾100, low high-density lipoprotein cholesterol (HDL-C) (mg/dL) <40 for men and <50 for women, and high triglycerides (TG) (mg/dL) ⩾150 mg/dL. Results: We found a significantly higher mean BMI (kg/m2) in the HBP group (30.5 ± 6.0) compared to T2DM (28.1 ± 5.9) and concomitant HBP and T2DM groups (29.4 ± 5.2) (ANOVA; P = 0.02). The most frequent dyslipidaemia was elevated LDL-C in 92 (96.8%) HBP, 73 (85.9%) T2DM and 79 (80.6%) concomitant disease. The frequency of low HDL-C was highest in T2DM (68.2%) compared to the other 2 groups (P = 0.03). Conclusions: Only TG levels were found to relate with any anthropometric index (waist circumference (WC) in this case) in Nigerians with major cardiovascular risk factors in this study. Routine anthropometric indices do not appear to be reliable surrogates for atherogenicity measured by abnormalities in TC, LDL-C and HDL-C. [ABSTRACT FROM AUTHOR]

Background and objectives: Obesity is a major risk factor for cardiovascular disease in developed and emerging economies. There is a paucity of data from Nigeria on the association between socioeconomic status and obesity. The aim of this study is to highlight that association in Abia State, South East Nigeria. Material and methods: This was a cross-sectional survey in South East Nigeria. Participating subjects were recruited from the three senatorial zones of Abia state. A total of 2,487 adults took part in the study. The subjects were classified based on their monthly income and level of educational attainment (determinants of obesity). Monthly income was classified into three groups: low, middle, and upper income, while educational level was classified into four groups: no formal education, primary, secondary, and tertiary education. Body mass index of subjects was determined and used for defining obesity. Data on blood pressure and other anthropometric measurements were also collected using a questionnaire, modified from the World Health Organization STEPwise Approach to Chronic Disease Risk Factor Surveillance. Results: Overall, the prevalence of obesity in low, middle, and upper income groups was 12.2%, 16%, and 20%, respectively. The overall prevalence of obesity in individuals with no formal education, primary, secondary, and tertiary education was 6.3%, 14.9%, 10.5%, and 17.7%, respectively. Educational status was found to be significantly associated with obesity in women, but not in men, or in the combined group. However, level of income was observed to be significantly associated with obesity in men, women, and in the combined group. Conclusion: Sociodemographic and socioeconomic factors are important determinants of obesity in our study population, and therefore may be indirectly linked to the prevalence and the outcomes of cardiovascular disease in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Developing countries of sub-Saharan Africa (SSA) face a double burden of non-communicable diseases (NCDs) and communicable diseases. As high blood pressure (BP) is a common global cardiovascular (CV) disorder associated with high morbidity and mortality, the relationship between gradients of BP and other CV risk factors was assessed in Abia State, Nigeria. Methods: Using the WHO STEPwise approach to surveillance of chronic disease risk factors, we conducted a population-based cross-sectional survey in Abia state, Nigeria from August 2011 to March 2012. Data collected at various steps included: demographic and behavioral risk factors (Step 1); BP and anthropometric measurements (Step 2), and fasting blood cholesterol and glucose (Step 3). Results: Of the 2983 subjects with complete data for analysis, 52.1% were females and 53.2% were rural dwellers. Overall, the distribution of selected CV disease risk factors was diabetes (3.6%), hypertension (31.4%), cigarette smoking (13.3%), use of smokeless tobacco (4.8%), physical inactivity (64.2%) and being overweight or obese (33.7%). Presence of hypertension, excessive intake of alcohol, smoking (cigarette and smokeless tobacco) and physical inactivity occurred more frequently in males than in females (p<0.05); while low income, lack of any formal education and use of smokeless tobacco were seen more frequently in rural dwellers than in those living in urban areas (p<0.05). The frequency of selected CV risk factors increased as BP was graded from optimal, normal to hypertension; and high BP correlated with age, gender, smokeless tobacco, overweight or obesity, annual income and level of education. Conclusion: Given the high prevalence of hypertension in this part of Nigeria, there is an urgent need to focus on the reduction of preventable CV risk factors we have observed to be associated with hypertension, in order to effectively reduce the burden of NCDs in Africa. [ABSTRACT FROM AUTHOR]

Background: There is an increase of obesity and other cardiovascular risk factors worldwide, but especially in developing countries where multifaceted transitions are occurring. There is need for more evidence for the cardiometabolic effect of changing lifestyles and urbanization in Nigeria. This study aimed at defining rural-urban differences in anthropometric parameters in two Nigerian communities of the same ancestral origin and to determine the cardiovascular risk correlates of these anthropometric measurements. This was a cross-sectional epidemiological study using stratified cluster sampling method. We studied 335 and 332 urban and rural dwellers respectively. A complete cardiovascular profile as well as anthropometric measurements was compared between the two populations. Results: All anthropometric indices considered in this study (weight, BMI, waist circumference, waist circumference/ height ratio, abdominal height; biceps, triceps, sub-scapular, abdominal, superior iliac skinfold thicknesses) were significantly higher in urban than in the rural population (p = <0.001). Overweight, obesity and hypertension were significantly prevalent among the urban population (p = <0.001) while there was no significant difference in the prevalence of dyslipidaemia (p = 0.096) and diabetes (p = 0.083) between the two cohorts. Females tend to have a higher chance of obesity than males although there was no gender difference in waist circumference and central skin fold thickness in the rural population. Age was the significant predictor of systolic blood pressure among the rural (R² = 0.157, β = 0.258, p = 0.016) and urban female population (R² = 0.201, β = 0.351, p = <0.001) while Abdominal height (R² = 0.16, β = 0.281, p = 0.001) and waist circumference (R² = 0.064 β = 0.064, p = .003) were predictors of systolic blood pressure in urban and rural men respectively. Conclusion: Anthropometric indices were significantly higher among the urban than the rural populations. Cardiovascular risks were equally more prevalent among the urban population. Appropriate health education and lifestyle modification strategies may reduce the increased burden of cardiovascular risk factors associated with rural-urban migration. [ABSTRACT FROM AUTHOR]

Background: Many drugs are available for control of hypertension and its sequels in Nigeria but some are not affordable for majority of the populace. This serious pharmacoeconomic question has to be answered by the nation's health economists. The objective of this study was to evaluate the cost-effectiveness of drugs from 4 classes of antihypertensive medications commonly used in Nigeria in management of hypertension without compelling indication to use a particular antihypertensive drug. Methods: The study employed decision analytic modeling. Interventions were obtained from a meta-analysis. The Markov process model calculated clinical outcomes and costs during a life cycle of 30 years of 1000 hypertensive patients stratified by 3 cardiovascular risk groups, under the alternative intervention scenarios. Quality adjusted life year (QALY) was used to quantify clinical outcome. The average cost of treatment for the 1000 patient was tracked over the Markov cycle model of the alternative interventions and results were presented in 2010 US Dollars. Probabilistic cost-effectiveness analysis was performed using Monte Carlo simulation, and results presented as cost-effectiveness acceptability frontiers. Expected value of perfect information (EVPI) and expected value of parameter perfect information (EVPPI) analyses were also conducted for the hypothetical population. Results: Thiazide diuretic was the most cost-effective option across the 3 cardiovascular risk groups. Calcium channel blocker was the second best for Moderate risk and high risk with a willingness to pay of at least 2000$/QALY. The result was robust since it was insensitive to the parameters alteration. Conclusions: The result of this study showed that thiazide diuretic followed by calcium channel blocker could be a feasible strategy in order to ensure that patients in Nigeria with hypertension are better controlled. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MS) amplifies hypertension (HTN) associated with increased risk of cardiovascular disease (CVD). MS components and other CVD risk measures were investigated in different stages of hypertension. 534 apparently healthy Nigerian traders aged 18-105 years were participants of a cohort study. The International Diabetes Federation (2005) and the National High Blood Pressure Education Program Coordinating Committee criteria were used for MS and HTN classifications, respectively. Anthropometric indices were obtained by standard methods. Levels of fasting plasma glucose (FPG), total cholesterol (TC), triglyceride (TG), and high-density lipoprotein cholesterol (HDLC) were determined by enzymatic methods, while low-density lipoprotein cholesterol (LDLC) was calculated. Data analysed statistically were significant at P < 0.05. 143 (26.8%), 197 (36.9%), and 194 (36.3%) of the traders had normotension, pre-HTN and HTN (stages 1 and 2), respectively. All indices tested except HDLC were significantly different among BP groups (P < 0.05).Waist to hip (WHR) and waist to height (WHT) ratios were significantly different between HTN groups (P < 0.05). HTN was associated with MS and female gender (P < 0.05). Metabolic alterations and significant HTN were observed. Treatment of the individual components of the syndrome and improvement of modifiable metabolic factors may be necessary to reduce MS and high BP. [ABSTRACT FROM AUTHOR]

Background: Dyslipidemia is a major risk factor for cardiovascular disease. Data are scanty on the prevalence and pattern of dyslipidemia in Nigeria. However, some studies on the subject are now becoming available. This article reviews these studies on the prevalence and pattern of this important risk factor for cardiovascular disease in Nigeria. Materials and Methods: Intensive internet search on studies done in different parts of Nigeria showing the prevalence and pattern of dyslipidemia in various focal groups that include apparently healthy individuals, the elderly, diabetics, hypertensives, and diabetic hypertensives was carried out. Results: Dyslipidemia was highly prevalent in all the geopolitical zones of Nigeria with the consistent pattern being low HDL-Cholesterol and high LDL-C. Overall, the prevalence of dyslipidemia ranged from 60% among apparently healthy Nigerians to 89% among diabetic Nigerians. Conclusion: Dyslipidemia is highly prevalent in Nigeria and health education to increase awareness of the need for and to actually screen for dyslipidemia will facilitate early detection and treatment. [ABSTRACT FROM AUTHOR]

Objective: To compare the frequency of occurrence of metabolic syndrome using three international definitions and to study the distribution of cardiovascular risk factors among newly diagnosed hypertensive Nigerian subjects. Design: Cross sectional study. Settings: Cardiology unit of LAUTECH Teaching Hospital, Osogbo, Nigeria. Participants: One hundred forty newly diagnosed hypertensive Nigerian subjects, and 70 normotensive controls (age- and sex-matched) were included in this study. Methods: Clinical history and relevant laboratory investigations were performed on all study participants. The definition of metabolic syndrome was based on three international definitions: World Health Organization (WHO), International Diabetes Federation (IDF), and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Ethical approval was obtained for the study. Statistical analyses were performed using SPSS 16.0. Results: There was no difference in age and gender distribution between the hypertensive subjects and controls. (55.14 ± 10.83 years, females 53.6% vs. 54.67 ± 10.89 years, females 52.9% respectively, P>0.05). The frequency of occurrence of metabolic syndrome among hypertensives was 34.5% according to WHO, 35.0% according to NCEP ATP III, and 42.5% according to IDF criteria. Visceral obesity and reduced high-density lipoprotein (HDL) were the other common cardiovascular risk factors among newly diagnosed hypertensive subjects. Female hypertensives had a higher prevalence of visceral obesity and low HDL. Conclusion: Frequency of occurrence of metabolic syndrome was similar using the NCEP ATP III and WHO definitions. However, the IDF definition resulted in a higher frequency because of the lower cut-off for waist circumference used for identification of visceral obesity. Metabolic syndrome is present in a significant proportion of newly diagnosed hypertensive subjects. Therefore, appropriate screening and treatment are required. [ABSTRACT FROM AUTHOR]

Objective To evaluate a simple cardiovascular risk management package for assessing and managing cardiovascular risk using hypertension as an entry point in primary care facilities in low-resource settings. Methods Two geographically distant regions in two countries (China and Nigeria) were selected and 10 pairs of primary care facilities in each region were randomly selected and matched. Regions were then randomly assigned to a control group, which received usual care, or to an intervention group, which applied the cardiovascular risk management package. Each facility enrolled 60 consecutive patients with hypertension. Intervention sites educated patients about risk factors at baseline and initiated treatment with hydrochlorothiazide at 4 months in patients at medium risk of a cardiovascular event, according to a standardized treatment algorithm. Systolic blood pressure change from baseline to 12 months was the primary outcome measure. Findings The study included 2397 patients with baseline hypertension: 1191 in 20 intervention facilities and 1206 in 20 control facilities. Systolic and diastolic blood pressure decreased more in intervention patients than in controls. However, at 12 months more than half of patients still had uncontrolled hypertension (systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg). Behavioural risk factors had improved among intervention patients in Nigeria but not in China. Only about 2% of hypertensive patients required referral to the next level of care. Conclusion Even in low-resource settings, hypertensive patients can be effectively assessed and managed in primary care facilities. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) remains a major cause of morbidity and a leading contributor to mortality worldwide. Over the next 2 decades, it is projected that there will be a rise in CVD mortality rates in the developing countries, linked to demographic changes and progressive urbanization. Nigeria has witnessed tremendous socio-economic changes and rural-urban migration which have led to the emergence of noncommunicable diseases. We set out to determine the prevalence of modifiable CVD risk factors among apparently healthy adult Nigerians. This is a descriptive cross-sectional study carried out at Katsina, northwestern Nigeria from March to May 2006. Subjects for the study were recruited consecutively from local residents, hospital staff and relations of in-patients of the Federal Medical Centre, Katsina using convenience sampling. Socio-demographic information, anthropometric measurements and blood pressure were obtained from the subjects in a standardized manner. Venous samples were collected for necessary investigations and analyzed at the hospital central laboratory. Findings: Three hundred subjects (129 males and 171 females) with a mean age of 37.6 ± 10.6 (range 18-75) years were studied. Prevalence of the modifiable cardiovascular risk factors screened for were as follows: generalized obesity 21.3% (males 10.9%, females 29.2%, p < 0.05), truncal obesity 43.7% (males 12.4%, females 67.3%, p < 0.05), hypertension 25.7% (males 27.9, females 24%, p > 0.05), type 2 diabetes mellitus 5.3% (males 5.4%, females 5.3%, p > 0.05), hypercholesterolaemia 28.3% (males 23.3%, females 32.2%, p < 0.05), elevated LDL-cholesterol 25.7% (males 28%, females 24%, p > 0.05), low HDL-cholesterol 59.3% (males 51.9%, females 65%, p < 0.05), hypertriglyceridaemia 15% (males 16.3%, females 14%, p > 0.05) and metabolic syndrome 22% (males 10.9%, females 30.4%, p < 0.05). Conclusions: We found high prevalence of CVD risk factors among apparently healthy adult Nigerians. In order to reduce this high prevalence and prevent subsequent cardiovascular events, encouragement of a healthy lifestyle is suggested. [ABSTRACT FROM AUTHOR]

Studies examining the prevalence of cardiometabolic diseases in African immigrants show that they are healthier on arrival to the U.S., but develop worse risk profiles closer to that of the general population when they live 10 years or longer in the country. This change has been attributed to dietary acculturation. To explore contextual factors associated with changes in dietary behaviors of recent immigrant families from Nigeria and Congo. Five online focus group interviews were conducted with recent Nigerian and Congolese immigrant adults (n = 20; Female = 19, Male = 1). Three focus groups were conducted in English and 2 were conducted in French. Most of participants (70%, n = 14) completed the voluntary demographics survey. On average, participants were 42 years old and had 4 children. Educationally, most had at least a bachelor's degree (72%). Participants were recruited from churches with large population of African immigrants and through leaders of the immigrant communities from the Midwest. Participants discussed dietary practices for their families, including the challenges of maintaining a healthy diet after immigration to the U.S. Preliminary findings from the ongoing thematic analysis are reported. Participants had high level of awareness of the influence of healthy food choices on risk factors for cardiometabolic diseases. The majority had the perception of "American food" as unhealthy, characterizing them as containing a high amount of sugar and salt. All participants preferred and mostly consumed foods they were familiar with before migration, including traditional African meals. Participants had several misconceptions regarding the nutritional value of certain food products. They reported that their school-age kids preferred Americanized over the traditional African meals. Participants and community leaders demonstrated high level of interest in receiving educational resources to make healthier food choices. The findings will help to develop culturally tailored interventions to reduce diet-related risks associated with cardiometabolic diseases. None. [ABSTRACT FROM AUTHOR]