CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 2, March/April 2022 AFRICA 57 HDL-C. Opoku and colleagues32 reported a lower risk of low HDL-C in hypertensive (OR 0.95; 95% CI 0.92–0.97) compared to normotensive subjects. Findings from the Illuminate study,50 a clinical trial of torcetrabip (a cholesteryl ester transfer protein inhibitor), showed a 75% increase in plasma HDL-C levels with a concomitant increase in CVD risk (HR: 1.58; 95% CI 1.14–2.19) and mortality. Furthermore, genetic evidence51,52 shows that low concentrations of HDL-C, attributable to Mendelian disorders, such as mutations in modulatory proteins [apolipoprotein A-I (apoA-I), ATP-binding cassette transporter (ABC1) and lecithin cholesteryl acyl transporter (LCAT)], do not translate to premature coronary heart disease. Speculations abound that alterations in key components of HDL-C metabolism, including apoA-I, LCAT or ABC1,52,53 may be the underlying mechanisms responsible for these paradoxical associations. In vitro studies have shown that oxidative modifications of apoA-I catalysed by myeloperoxidase results in impaired cholesterol efflux of apoA-I, independent of HDL-C concentration.54 Taken together, one may deduce that HDL-C functionality rather than quantity may be the inherent property directly responsible for its atheroprotective properties, including anti-inflammatory, anti-oxidant and nitrous oxide-promoting effects. Strengths and limitations Our study investigated for the first time the burden and predictors of dyslipidaemia in a nationally representative population of Nigeria. In addition to this, our subjects were drawn from rural and urban communities to evaluate the changing patterns of rural–urban differences in dyslipidaemia, which are widely reported with other CVD risk factors in many developing populations. We achieved all these by deploying standardised WHO-STEPs protocols. In a bid to ease comparison with past and future studies, we carefully selected the WHO criteria over other criteria for diagnosing dyslipidaemia, as it is perceived to be one of the most frequently used criteria in African studies.7 Our findings should be interpreted within the context of the following limitations. Our study may have underestimated the burden of dyslipidaemia as our estimations were obtained without recourse to the level of awareness, treatment and control of dyslipidaemia in the population. The causal nature of associations between risk factors and the different forms of dyslipidaemia were not investigated. The associations reported in this study were entirely observed and based on a mere co-existence of the predictors and supposed outcomes. Conclusion The prevalence of dyslipidaemia, particularly low HDL-C, is high among adult Nigerians, and factors that are majorly associated with it include hypertension, diabetes mellitus, obesity and residing in rural areas. The high prevalence of dyslipidaemia in Nigeria suggests that dyslipidaemia may contribute substantially to the large burden of CVD and its risk factors in this region. There is a need to intensify inexpensive measures such as increasing awareness, training experts in dyslipidaemia management, and educating against sedentary lifestyle and unhealthy dietary habits, especially in rural areas where poverty is high and access to health services is a major challenge. Using dyslipidaemia as a prime target of obesity, diabetes mellitus and hypertension could prove to be central in the fight against CVDs in Nigeria. Therefore, screening of high-risk individuals for dyslipidaemia should be encouraged. The authors gratefully acknowledge the traditional and community leaders who supported the REMAH project by mobilising their respective communities to participate. They include His Royal Highness Igwe Charles Anikweze, Nnamenyi III of Awkuzu, Ven Isreal Odita, the archdeacon, Omagba Archdeaconry (Anglican Communion) Onitsha; His Royal Highness (HRH) Monday Udoewah, the clan head of Ubium clan, Nsit Ubium LGA, Akwaibom State; Mr Habila N Garba, district head of Ture, Ture district office, Kaltungo chiefdom, Kaltungo LGA, Gombe State; Alhaji Adamu Musa, Chairman Shongo Housing Estate Residents Association (SHERA) Gombe State; HRH Alhaji Attahiru Bungudu, Emir of Bungudu, Zamfara. Worthy of acknowledging are Prof Oladimeji Oladepo, Department of Health Promotion and Education, Public Health College, University of Ibadan; Venerable JS Adekoya, St Paul’s Anglican Church, Agbowo and Mrs Grace Adekoya, Assistant Director Public Health Nursing for the roles they played to facilitate community penetration in Ibadan. Maureen Amaechi provided valuable administrative and clerical support to REMAH project. 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