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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018
106
AFRICA
Prevalence of cardiometabolic risk factors among
professional male long-distance bus drivers in Lagos,
south-west Nigeria: a cross-sectional study
Casmir E Amadi, Tim P Grove, Amam C Mbakwem, Obianuju B Ozoh, Oyewole A Kushimo, David A Wood,
Michael Akinkunmi
Abstract
Background:
Professional drivers are known to be at high
risk of cardiovascular disease (CVD). This study was carried
out to highlight these risk factors and their predictors among
male long-distance professional bus drivers in Lagos, south-
west Nigeria, with a view to improving health awareness in
this group.
Methods:
Socio-demographic data, anthropometric indices,
blood pressure, fasting plasma blood glucose levels and lipid
and physical activity profiles of 293 drivers were measured.
Results:
Mean age of the study population was 48
±
9.7 years;
71.0 and 19.5% of the drivers used alcohol and were smokers,
respectively; and 50.9% were physically inactive. The preva-
lence of overweight and obesity was 41.7 and 21.1%, respec-
tively, while 39.7 and 13.9% were hypertensive and diabetic,
respectively. Ninety (31.3%) subjects had impaired fasting
glucose levels while 56.3% had dyslipidaemia. Predictors of
hypertension were age and body mass index (BMI). BMI only
was a predictor of abnormal glucose profile.
Conclusion:
Professional male long-distance bus drivers in this
study showed a high prevalence of a cluster of risk factors
for CVD.
Keywords:
cardiovascular disease, risk factors, long-distance
drivers
Submitted 26/5/17, accepted 14/1/18
Published online 19/2/18
Cardiovasc J Afr
2018;
29
: 106–114
www.cvja.co.zaDOI: 10.5830/CVJA-2018-006
Atherosclerotic cardiovascular disease (CVD), typified by
coronary heart disease (CHD) and stroke, is a pre-eminent cause
of preventable and premature mortality globally, accounting
for about 30% of global deaths.
1
This is expected to increase by
almost 50% by 2030.
2
It is also a major cause of mass disability
and a somatic cause of loss of productivity globally, with over
150 million disability adjusted life years (DALYS).
3
About 80%
of this burden from CVD is borne by low- and middle-income
countries (LMIC).
1
Globally, CVD prevalence is on the increase, remarkably
so in the LMIC. This is largely due to increased urbanisation
and its corollary of better socio-economic opportunities and
Westernisation of lifestyles, such as sedentary living, unhealthy
dietary choices, tobacco use, psycho-social stress and harmful
use of alcohol.
4
These behavioural risk factors predispose to
intermediary or metabolic risk factors, such as hypertension,
abnormalities in blood glucose levels, dyslipidaemia, overweight
and obesity.
5,6
One of the socio-economic consequences of urbanisation is
mass transit of people, goods and services across regions and
long distances via land, air and waterways. The consequence of
this is the creation of effective road transport systems in urban
areas, with an increase in the number of people engaged in
professional driving.
Professional drivers as an occupational group are at increased
risk of CVD. Morris
et al
., in their seminal research in 1953,
documented that London bus drivers were at increased risk for
CHD compared to the more active bus conductors.
7
Several other
occupational epidemiological studies have provided evidence that
professional drivers (short- and long-distance drivers) suffer more
and die fromCVD.
8-11
This excess of CVDmorbidity and mortality
risk among this group is attributable to a high prevalence of CVD
risk factors, such as obesity, hypertension, sedentary living,
diabetes, smoking and unhealthy diets found in them.
12-14
Beyond these conventional risk factors for CVD, various
driving-related activities, such as traffic congestion, ergonomic
factors, long-distance driving, shift work, and anxiety and
tension from the job of driving have also been implicated.
These are known to cause various neuroendocrine and
neurocardiological responses, such as increased secretion of
cortisol and catecholamines, and decreased heart rate variability,
which may also be possible mediators of CVD.
15,16
They can
also be considered a vulnerable group with social gradients of
inequalities; they usually belong to the lower socio-economic
class, are not well educated/informed and are not usually covered
by public health policies. They also work under immense anxiety
and stress. These further heighten their risk for CVD.
Lagos is the second most populous city in Nigeria, the second
fastest growing city in Africa and the seventh in the world.
17
It is
Department of Medicine, College of Medicine, University of
Lagos, Nigeria
Casmir E Amadi, MD,
acetalx@yahoo.comAmam C Mbakwem, MD
Obianuju B Ozoh, MD
National Heart and Lung Institute, Imperial College, London
Tim P Grove, MSc
David A Wood, PhD
Department of Medicine, Lagos University Teaching
Hospital, Nigeria
Oyewole A Kushimo, MD
Michael Akinkunmi, MD