CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 1, January/February 2010
30
AFRICA
in the study population prompted review for further manage-
ment by a more senior member of the health team more often
than detection of high blood pressure. We discovered that urine
was tested in a few cases during antenatal care and in those who
had observed the unusual presence of sugar ants around their
latrines. Since urine testing is readily available and assessable in
this community, the service can be up-scaled for early detection
of diabetes.
The clustering of cardiometabolic risk factors in middle age
is also worthy of note, indicating the need for a comprehensive
and integrated approach to tackle CVD. It has been observed
that the average human being is likely to experience a rise in
body weight and blood pressure with age under the conditions
of modern life.
23
The REACH registry showed that most hyper-
tensive patients have additional CVD risks.
33
None of the partici-
pants had had an assessment of their lipid profiles prior to this
study. We discovered that the PHCs had no facility for the test-
ing of lipids; moreover, the health givers lacked the knowledge
of the role of lipids in CVD. Low levels of HDL-C were found
in 43.1% of the study population despite the relatively normal
levels of total cholesterol and triglycerides. In south Asians
70.3% were found to have HDL-C lower than 40 mg/dl.
34
Cigarette smoking was uncommon in the study population;
however, the impact of smokeless tobacco use on CVD remains
to be further elucidated, especially as this was found to be
restricted to women. This was unlike the high prevalence of ciga-
rette smoking in South African men, but the number of cigarettes
smoked was equally low.
35
Abdominal obesity was more common in our study popula-
tion, with 8.5% having increased risk and 6.2% having substan-
tially increased risk, compared to 6.4 and 1.6%, respectively, as
recorded in a previous study in Nigeria.
36
This may suggest an
apparent upward trend in this risk factor within the past decade
due to increased exposure to a westernised lifestyle. Previous
studies have shown that waist circumference was positively
correlated with blood pressure and fasting blood glucose and
was significantly associated with higher risks of hypertension
and diabetes in Nigerians, Jamaicans and African-Americans.
37
Two per cent of our study population were obese with a BMI
>
30 kg/m
2
, unlike a higher rate of 8% found in an inner-city
urban community in Nigeria (the two studies reported that more
women than men were obese).
38
We recommend that abdominal
obesity be used in defining CVD risk factors in this population,
rather than overall obesity.
Limitations of this research
We were able to study only one of the diverse ethnic groups
dwelling in rural areas of Nigeria, and different regions of the
country are known to be at different levels of acculturation to a
western lifestyle. Insulin resistance and C-reactive protein were
not estimated in this study in order to reduce costs; however these
would not have affected the outcome of our study objectives.
Conclusion
The relatively high rate of cardiometabolic risk factors in this
rural population is an indication that the epidemic of CVD
is looming large in Nigeria, a country whose health services
are already overburdened by tuberculosis and the HIV/AIDS
epidemic. Results of this study could serve as a basis for advoca-
cy, with an urgent call for action for the development of national
programmes that would improve the control and management of
cardiometabolic risk factors and CVD, along with other NCDS.
Primordial and primary population-based strategies, lifestyle
modification, health education and health promotion would be
cost effective in reducing CVD morbidity and mortality in this
low-resource setting. Increased consumption of fruit and vegeta-
bles, use of appropriate cooking oil, and reduction of salt in food
are good starting points for modifying some of these risk factors.
Although the rate of cigarette smoking is low, smoking should be
discouraged further.
We are grateful to the authorities of ELGA, the gatekeepers/key opinion
leaders and the participants who gave their time, support and enthusiasm in
making this study a success. The study was funded in part by the country
office of the WHO. The work was carried out at the Cardiovascular Unit,
Department of Medicine, University College Hospital, College of Medicine,
University of Ibadan, Nigeria.
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