Prevalence of Risk Factors Associated With Cardiovascular Disease Among Adults
CHAPTER ONE
General Objective
The general objective of this study was to determine the prevalence of the risk factors associated with cardiovascular diseases among adults working in federal government establishments in Umuahia, Abia state, Nigeria.
Specific objectives
The specific objectives of the study were to
- determine and classify the body mass index (BMI) of the respondents
- determine the blood sugar level of the respondents
- determine the blood pressure of the respondents
- assess the food consumption pattern of the respondents using food frequency
- compare the body mass index, blood glucose level and blood pressure of the male respondents to their female counterparts
CHAPTER TWO
LITERATURE REVIEW
Cardiovascular diseases
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They include heart failure, atherosclerosis, stroke, angina pectoris, coronary heart disease cardiomyopathy and arrhythmia.
Atherosclerosis
Atherosclerosis (also known as arteriosclerosis vascular disease or (ASVD) is the condition in which an artery wall thickens as the result of a build-up of fatty materials such as cholesterol. It is a syndrome affecting arterial blood vessels, a chronic inflammatory response in the walls of arteries, in large part due to the accumulation of macrophage white blood cells and promoted by low-density lipoproteins (plasma proteins that carry cholesterol and triglycerides). It is commonly referred to as a hardening or furring of the arteries. It is caused by formation of multiple plaques within the arteries (Maton et al.,1993). Atherosclerosis, though typically asymptomatic for decades, eventually produces two main problems:
First, the atheromatous plaques, though long compensated for by artery enlargement, eventually lead to plaque ruptures and then clots inside the artery lumen over the ruptures. The clots heal and usually shrink but leave behind stenosis (narrowing) of the artery or complete closure and therefore, an insufficient blood supply to the tissues and organ it feeds (Glagov, Weisenberg. Zarins, Stankunavicius & Kolettis, 1987). Second, if the artery enlargement process is excessive, then a net aneurysm results. These complications of advanced atherosclerosis are chronic, slowly progressive and cumulative. Most commonly, soft plaque suddenly ruptures, causing the formation of a thrombus that will rapidly slow or stop blood flow leading to death of the tissues fed by the artery in approximately 5minutes. This catastrophic event is called an infarction (Glagov et al., 1987).
Causes of atherosclerosis
Atherosclerosis develops from low-density lipoprotein (LDL) molecules becoming oxidized by free radicals, particularly reactive oxygen species (ROS). When oxidized LDL comes in contact with an artery wall, a series of reactions occur to repair the damage to the artery wall caused by oxidized LDL. The LDL molecule is globular shaped with a hollow core to carry cholesterol throughout the body. Cholesterol can move in the blood stream only by being transported by
lipoproteins (Blankenhorn & Hodis, 1993). The body’s immune system responds to the damage to the artery wall caused by oxidized LDL by sending specialized white blood cells (macrophages and T-lymphocytes) to absorb the oxidized LDL forming specialized foam cells. Unfortunately, these white blood cells are not able to process the oxidized LDL which ultimately grow, then rupture depositing a greater amount of oxidized cholesterol into the artery wall. This triggers more white blood cells continuing the cycle. Eventually, the artery becomes inflamed. The cholesterol plaque causes the muscle cells to enlarge and form a hard cover over the affected area. This hard cover is what causes a narrowing of the artery, reduces blood flow and increases blood pressure (Blankenhorn & Hodis, 1993).
Coronary Heart Disease
Coronary heart disease refers to the failure of coronary circulation to supply adequate blood to cardiac muscle and surrounding tissue. It is already the most common form of disease affecting the heart and causing premature death globally (Boon, College, Walker & Hunter, 2006). It is most commonly equated with atherosclerotic coronary artery disease but coronary heart disease can be due to other causes such as coronary vasospasm (Williams, Resticaux & Low, 1998). Coronary heart disease has many risk factors including smoking, hypertension, diabetes and hyperlipidemia.
CHAPTER THREE
MATERIALS AND METHODS
Area of study
Umuahia is the capital of Abia State in Southeastern Nigeria. It is located along the railroad that lies between Port Harcourt to its south and Enugu city to its north. Its indigenous ethnic group is the Igbos. Umuahia is known for being an agricultural market center. It is also a railway collecting point for crops such as yam, citrus fruits, and palm oil. The dwellers are predominantly civil servants with less businessmen and farmers. It has a population of 359,230 according to Nigeria census in 2006.
Study population
The study population included all men and women above 30 years working in Federal government establishments in Umuahia town. There are more than 10 establishments owned by the Federal government. Some of them are:
- Federal Ministry of Education
- Federal Ministry of Agriculture
- Federal Ministry of Labour and Productivity
- Federal Ministry of Internal Affairs
CHAPTER FOUR
RESULTS
Table 4.1 shows the demographic data of the respondents in terms of their age, marital status, ethnic group, highest educational qualification and income level. A high percentage of the respondents (32%) were within the age range of 30-40 years and 24% were within 41-45 years while 7% were within 56-60 years. Majority of the respondents were married (86%), 12% were single and 1% were widowed and divorced. Ninety-five percent of the respondents are from Igbo ethnic group, 3% are from Yoruba and 7% are from other ethnic groups in Nigeria. Ten percent of the respondents had only primary education, 25.5% had secondary education and 64.5%had tertiary education. Twenty three percent of the respondents earned between N18,000 and N30,000 monthly while 33.5% and 22.5% earned monthly income between N30,001-N50,000 and N50,001-N70,000 respectively. Twelve percent of the respondents had a monthly income of N70,001-N90,000 while9% of the respondents earned above N90,000.
CHAPTER FIVE
DISCUSSION
This study was conducted among healthy adults working in Federal Government Establishments in Umuahia, Abia State to determine the prevalence of risk factors to cardiovascular diseases. These risk factors include:
Obesity:
The higher prevalence of obesity in females than in males was not a surprise. Wahab et al. (2011) had earlier reported a higher prevalence rate of obesity in women (15.75%) than in men (5.25%) among an adult population in northern Nigeria. Another group of researchers reported higher prevalence rate of obesity among women (39.5%) than men (14.5%) in an Iranian population (Rashidy-Pour, Malek, Eskandarian and Ghorbani, 2009). Yadav & Krishnan (2008) observed among adults in an urban population in India, higher prevalence rate of obesity among women (12.6%) than men (5.5%).
The overall prevalence rate of obesity reported in the present study (18.5%) was similar to that reported among urban dwellers in Republic of Benin (18%) (Sodjinou, Agueh, Fayomi & Delisle, 2008). A similar study among urban adult residents in Ghana reported the prevalence of obesity as 13.6% (Amoah, 2003). This was lower than the value reported in the present study. Previous studies carried out among adult women alone have reported various findings. A study carried out among adult women in a University Community in western Nigeria reported the prevalence of obesity as high as 21.2% (Ojofeitimi et al.,2007) and another study among adult eastern Nigeria women reported 20.7% prevalence of obesity (Osuji et al., 2010). These two reports from Nigeria surprisingly differed from the prevalence of obesity among women in the present study (13.5%). In Ethiopia, the prevalence of obesity among adult women in Addis Ababa was reported as 10.8% (Tesfaye, Byass & Wall, 2009).Another similar study in Malaysia reported the prevalence was 16.7% (Sidik & Rampal, 2009). The prevalence of obesity in the present study is similar to some studies but it was higher or lower than other reports. The fact is that Nigeria is undergoing nutrition transitions. Many fast food outlets are springing up in many cities and they have high patronage. This precipitates consumption of energy dense foods and will probably cause higher prevalence of obesity in the next few years if unchecked.
CONCLUSION
As judged by the results, the prevalence of obesity, hypertension and diabetes among respondents were relatively high (18.5%, 21% and 5%).This calls for urgent intervention to reduce the prevalence. The risk factors for cardiovascular diseases were more prevalent among younger age groups (30-40 years).Obesity was more prevalent in females than the male respondents. It was found more prevalent also among respondents that had one level of tertiary education or the other (OND and BSc) and respondents that earned less than N70.000. Blood sugar values of both male and female respondents were not statistically different. The blood sugar of respondents within the age range of 56-60 years was significantly higher than that of other age groups. Blood pressure values of both the male and female respondents were similar. The systolic blood pressure of respondents in the age ranges 30-40 years and 56-60 years were different from each other but were similar to the other age ranges. The diastolic blood pressure values within all the age ranges were similar. Marital status, income level and the subjects’ BMI, blood pressure and blood sugar level were not related. Only 36.5% of the respondents had regular medical checks.
RECOMMENDATIONS
Based on this study, it was recommended that
- Nutrition education programmes should be organized for staff of government institutions and the importance of healthy feeding practices should be
- The nutrition education programmes should emphasize the adverse effects of sedentary lifestyle as well as low physical exercise in the prevalence of obesity and its’
- Regular medical checkup should be encouraged to detect early onset of risk factors of cardiovascular
- Regular consumption of indigenous foods, fruits and vegetables and high in fibre diets to reduce emergence of obesity, diabetes and hypertension are
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