Cardiovascular Journal of Africa: Vol 27 No 5 (September/October 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 5, September/October 2016 326 AFRICA
need for appropriate preventative and therapeutic intervention to
retard progression and prevent poor outcomes, with our limited
health resources. Access to healthcare will increase utilisation of
health facilities, provide early intervention through medication
and lifestyle changes, and ensure regular monitoring. Policies on
good dietary audits and healthy lifestyles should be developed
and effectively implemented. Regular screening of populations
at risk should also be encouraged.
There is evidence that therapeutic interventions are effective
in treating overt medical conditions such as diabetes and
hypertension, both of which in this study contributed significantly
to clustering of risk factors.26,27 Similarly, obesity was associated
with clustering of risk factors. This is in agreement with reports
by Bayauli et al.28 in Congo and Dahiru29 in northern Nigeria.
The odds of clustering of cardiovascular risk factors increase
with degree of obesity. In 2010, about 3.6 million deaths were
estimated to result from overweight and obesity, with 3.9% years
lost and 3.8% lost in disability-adjusted life-years.30 Prevalence of
obesity has increased, not only in adults but also among children
and adolescents in both developed and developing countries.
Increased adiposity is a significant risk factor for atherogenesis
and increased coagulability. Obesity is described as a chronic and
systemic inflammatory disease as a result of the release of enormous
pro-inflammatory cytokines and increasing insulin insensitivity. The
rising prevalence of obesity is a threat to global health.
Microalbuminuria also increased the odds for cardiovascular
risk clustering. Its presence suggests endothelial damage and
it is an independent atherosclerotic risk factor.31 Its detection
underscores high risk of cardiovascular disease and all-cause
mortality, not just among people with diabetes but also in the
general population.32,33 Prompt treatment of microalbumiuria
among patients with diabetes, for instance, significantly
ameliorates associated morbidity, such as diabetic nephropathy,
which is usually a serious consequence. However, in view of the
clustering of risk factors, multiple therapeutic approaches are
suggested. This ensures coverage of most of the risk factors, as
recommended in the guidelines.34,35
Varying reports have stressed the driving effect of hypertension
and insulin resistance on other cardiovascular diseases. In this
study, increasing blood pressure and plasma glucose levels were
independently associated with increasing odds of clustering
of risk factors. Few other studies have refuted the possible
association, especially insulin resistance and other risk factors.
Our study demonstrated that each of the cardiovascular risk
factors has varying degrees of clustering. The interplay among
these various factors leads to similar physiological and structural
dysfunction. For instance, microalbuminuria, insulin insensitivity
and diabetes are associated with endothelial dysfunction.36 Sloten
et al. therefore suggested therapeutic interventions that would
target the common pathology and control risk factors that
interact rather than those that do not interact.37
Our study has some limitations. It was a cross-sectional
study. We were unable to discuss the sequence of events, and
causality could not be established for cardiovascular events. The
diagnoses of diabetes and hypertension were made during one
visit, although protocols as recommended in the guidelines were
strictly adhered to. Also, microalbuminuria was checked only
once, as efforts to collect the samples after three months were
frustrated by poor participation. On average, about one out of
four initial participants re-presented for the second screening.
This was terminated after the third community was visited, with
the same experience.
Conclusion
This study has shown not only the presence of cardiovascular
risk factors, as in other studies, but also a high prevalence of
clusters of such risk factors. The pattern of clustering showed
significant association with conventional cardiovascular risk
factors. These clusters will increase the health burden, promote
rapid progression to end-organ damage and increased mortality
rates if there is no planned and appropriate intervention.
This is of great concern as it also portends a dwindling socio-
economic status in developing nations. It is important to stress
a comprehensive approach of primary, secondary and tertiary
preventative measures and control of these factors in order to
reduce the overall burden of cardiovascular diseases.
We acknowledge the royal fathers and community leaders for their support.
We also thank members of staff of the Comprehensive Health Centre, Ilie,
and the supporting staff of the Department of Community Medicine, Federal
Teaching Hospital, Ido-Ekiti.
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