Ignore your heart, at your own risk

I was at work in London, that afternoon, in 2009, when in between meetings, my phone buzzed and I picked it up to glance at it. The text was from my younger brother and it contained devastating news- one of my oldest friends, someone I had been at secondary school with, someone I had shared a room with in our first year at university was dead. He had been found slumped at his desk in his office in Lagos, an otherwise healthy husband and father, not yet forty.

In the dark days that followed, as I and his many friends struggled to make sense of the news, I sought to understand if he had suffered from high blood pressure or diabetes, if he had had anything that may have led to what I was convinced was a sudden cardiac death. There did not appear to be any conclusive evidence, and even the autopsy carried out later was said not to have found anything significant. This was not my first encounter with sudden unexplained death in Nigeria, many years before, a beloved uncle had collapsed on the lawn tennis court, just hours after I had last seen him. Again there was little information about the circumstances, but looking back I am inclined to believe that my friend and my uncle had both succumbed to cardiovascular disease. Although neither of them smoked or were overweight, and although both were fairly physically active; being African, they were at greater risk of cardiovascular disease- the diseases of the heart and circulation including coronary heart disease (angina and heart attack), heart failure, congenital heart disease and stroke.

Our poor medical record keeping in Nigeria meant that it was difficult to establish if they had any of the other risk factors for cardiovascular disease: Did my friend and my uncle have high blood pressure? What about high blood cholesterol? Or diabetes? Is there a history of heart disease in their families? And most importantly, could their deaths have been prevented?

The World Health Organization has recognized that the burden of non-communicable diseases in Africa is likely to increase substantially overthe next few decades, and will become one of the most important causes of death and disability. Although most attention has focused on communicable diseases (malaria, HIV, tuberculosis), there is an increasing awareness of the growing burden of non-communicable disease, a significant part of which is cardiovascular disease.

This challenge poses many questions for everyone with an interest in the Nigerian health sector- from the issue of raising awareness and promoting healthy lifestyles at an individual and population level, to a greater understanding of the local context and the provision of resources for prevention and treatment of these diseases. The recent NOI poll, conducted in partnership with EpiAFRIC is therefore very timely.

Read more about it below:

Cardiovascular disease (CVD) includes all the diseases of the heart and circulation including coronary heart disease (angina and heart attack), heart failure, congenital heart disease and stroke. It is also known as heart and circulatory disease. Blood flow to the heart, brain or body can be reduced as a result of a blood clot (thrombosis) with or without build-up of fatty deposits inside an artery,  leading to the artery hardening and narrowing (atherosclerosis). The World Health Organization (WHO) reported that cardiovascular disease caused the deaths of more than 17 million people in 2008. An estimated 12% of Nigerians die from cardiovascular disease.

NOIPolls and EpiAFRIC have worked together to conduct a rapid poll on cardiovascular disease among Nigerians. Using a questionnaire jointly designed by
EpiAFRIC and NOIPolls, we collected data from 1,000 Nigerians sampled in a way that reflects the population of the country. The objective of the poll was to estimate the exposure of a sample of Nigerians to known risk factors for CVD.

We looked at three of these risk factors, namely hypertension (high blood pressure), extra weight (overweight or obesity) and smoking (cigarettes and/or other forms of tobacco). They can be reduced by a healthy life style that includes healthy eating, exercising and avoiding tobacco.

Our joint findings were:

What it means for you!

Our poll suggests that we have to be more aware of the life style choices that we make which increase our risk for cardiovascular disease. These findings suggest that a high proportion of Nigerians are overweight and we do not exercise enough. While the poll may suggest relatively low levels of smoking, given the contribution of smoking as a risk factor for CVD and cancer, quitting has to remain a priority. Regularly checking your blood pressure to identify and treat hypertension is critical in reducing the risks of CVD. In designing programmes to tackle these issues, targeting groups with higher risk, such as men and people in the North East when addressing smoking, should be considered.

We are conscious that participants in this poll, like all self-reported surveys may have under-reported socially unacceptable behavior or been unable to recall key relevant information. For instance, the low proportion of respondents with high blood pressure is probably an underestimate as most other studies, in which blood pressure has actually been measured have shown a prevalence of 30 – 40% among Nigerians.