Coronary Artery Disease and the Profile of Cardiovascular Risk Factors in South South Nigeria: A Clinical and Autopsy Study

Abstract

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%) of 747 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, poor physical activity, and obesity. Nigerians in this locality with CAD have raised serum lipids.

Prevalence and pattern of cardiovascular-related causes of out-of-hospital deaths in Lagos, Nigeria

“…This is particularly relevant to Nigeria where low patronage of orthodox health facility has been reported,10 and may buttress the possibility of an actual higher prevalence of coronary-artery-disease in Nigerians. The equal gender distribution of myocardial-infarction in our study contrasts with the reported higher prevalence in males in other studies 3,11,24. This can be explained by the known higher incidence of acute myocardial-infarction in older women (as seen in our study) such that the prevalence in them equals that in men with advancing age 19,32.…”

“…The finding of myocardial-infarction in 8.9% of our subjects is much lower than the prevalence of coronary-artery-disease in autopsied out-of-hospital sudden deaths in China (50.3%), India (56.9%) and Ireland (75.0%) 3,29,30. It however suggests a possible increasing prevalence of coronary-artery-disease in Nigerians as studies from earlier years had reported prevalence rates ranging from 0% to 6.3% in coroner's autopsy cases 9,11,22. This apparent increasing prevalence is in keeping with the WHO's projected doubling mortality from CAD by year 2020 with 82% of the contribution expected to be from developing countries 12.…”

“…Data on out-of-hospital mortality is sparse in this environment. In one centre in Nigeria, CAD prevalence in coroner's autopsy was 1.6% while only 41 clinical cases out of 110,000 patients were seen 11. Mortality rate from CAD was expected to double between 1990 and 2020 with about 82% of the contribution from developing countries 12…”

Cardiac surgery publications in Africa over the last 20 years: A literature review

“…12 Nigeria has a coronary artery disease prevalence of 16 per 1000, with those affected being predominantly male and urban-dwelling individuals. 13 Despite this growing burden of cardiovascular disease, cardiovascular surgery needs are not being met. Cardiac surgery needs have been estimated to be 200 operations per million in low-income countries and >1000 operations in high-income countries non-endemic to rheumatic heart disease.…”

The association between statin-use and diet, exercise, and perceptions of high cholesterol in urban and semi-urban Nigerians: a cross-sectional study.

“…The rise of cardiovascular diseases and other non-communicable diseases in sub-Saharan Africa has been attributed to an aging population and urbanisation (5)(6)(7)(8)(9). A key strategy for the primary prevention of cardiovascular disease is the lowering of lipid levels (2,10).…”