Non-laboratory-based cardiovascular risk assessment:  10-year absolute risk, predicted heart age and intervention requirements in a Nigerian population

Abstract

BACKGROUND: Population-based data on cardiovascular disease (CVD) risk burden are essential for effective planning of CVD reduction strategies. There is paucity of such data in Nigerians. We aimed to determine the 10-year absolute CVD risk and heart age profile of adult Nigerians; to identify the most frequent absolute CVD risk-determining factors and the required treatment interventions. METHODS: This was a secondary analysis of data of 3620 adults aged 30-80 years (51% females) from a population-based cross-sectional hypertension survey in Lagos, Nigeria. A non-laboratory-based CVD risk-assessment framework was used to estimate the 10-year absolute CVD risk and predict the heart age profiles. The WHO PEN was used to identify the treatment intervention requirements. RESULTS: A total of 316 (8.7%) persons, 218 (12.3%) of males and 98 (5.3%) of females had a 10-year absolute CVD risk ≥ 20%, p < 0.0001. Elevated systolic BP (918 (25.4%)) and excess BMI ((overweight: 1072 (29.6%), obesity: 638 (17.6%)) were the most frequent absolute CVD risk determining factors in the population. Excess BMI occurred more frequently in females (p < 0.0001) while the frequency of elevated systolic BP was similar in both sexes (p = 0.091). High excess heart age (EHA) (≥ 5 years) was present in 1531(42.3%) persons; 798 (45.0%) of males and 733 (39.7%) of females, p < 0.0001. Only 521(14.4%) of the total population needed any treatment intervention, compared to 269 (85.1%) of persons with absolute CVD risk ≥ 20%, and 469 (30.6%) with high EHA. Antihypertensive treatment alone (n = 149 (47.2%)) or in combination with statin and aspirin (n = 85 (26.9%)) were the most frequently required interventions in individuals with CVD risk ≥ 20%. CONCLUSION: A significant proportion of our population has high CVD risk. Strategic policies promoting healthy lifestyles, strengthening the health system for focused risk-based screening, and prioritization of treatment interventions could help lower this risk.