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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 14  |  Issue : 2  |  Page : 71-74

Rising trend of cardiovascular diseases among South-Western Nigerian female patients


Department of Clinical Pharmacology, University College Hospital; Depament of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria

Date of Web Publication26-Oct-2017

Correspondence Address:
Aduragbenro Deborah Adedapo
Depament of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njc.njc_23_17

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  Abstract 

Background: Developing countries though faced with increasing burden of cardiovascular disease have the least contribution in articles published on cardiovascular research. There is a paucity of report on the trend of cardiovascular diseases particularly no report is available on the trend in Nigerian female patients. The aim of this study is to determine the trend of cardiovascular diseases and the gender effect.
Materials and Methods: A retrospective analysis of medical admission in a public, secondary health center over a 5-year period (1997–2001) was carried out.
Results: Of the 2474 patients, 37.0% with a mean age of 54.9 (14.6) years had cardiovascular diseases, 51.3% were females. Mean duration of hospital stay was 11.8 (9.1) days, range 1–90 days. This was a significant steady rise in the trend of cardiovascular disease which was higher among females (P = 0.003). Hypertension and hypertension-related complications constituted the bulk of cardiovascular diseases. Overall mortality was 155 (17%) for cardiovascular diseases although not significantly different gender wise was higher in males (86, 55.5%), P = 0.063.
Conclusion: Targeted research and control of cardiovascular diseases among women may enhance the control of the menace of cardiovascular diseases.

Keywords: Cardiovascular disease, female, Nigeria, trend


How to cite this article:
Adedapo AD. Rising trend of cardiovascular diseases among South-Western Nigerian female patients. Nig J Cardiol 2017;14:71-4

How to cite this URL:
Adedapo AD. Rising trend of cardiovascular diseases among South-Western Nigerian female patients. Nig J Cardiol [serial online] 2017 [cited 2017 Dec 10];14:71-4. Available from: http://www.nigjcardiol.org/text.asp?2017/14/2/71/217275


  Introduction Top


Developing countries though faced with increasing burden of cardiovascular disease have the least contribution in articles published on cardiovascular research; majority originating from Western Europe and the USA.[1],[2] There is a call for the need to increase the contribution of Africa in the published articles, especially to monitor the trend of cardiovascular diseases to assess the efficacy of control programs.[3] Few studies are available on the trend of cardiovascular diseases in Nigeria. An increased trend in the prevalence of hypertension was observed in urban Nigeria.[4] Marked increase in the prevalence of cardiovascular disease of 150% has been reported, but gender effect was not explored.[5] The review of hospital admission records of patients particularly when related to age groups and demographic trends provide one of the best sources of such health information.[6]

Admission or registry records may be a reflection of the real world as observed by Taggart who also sounded some caution in the widespread application of the results of randomized clinical trials.[7] However, in the developing countries, most reviews of medical records for health information are obtained from the tertiary centers clearly indicating a dearth of information from the secondary health-care centers; where if available it had spanned two or three decades.[8] In many developing countries, there are three levels of health-care system, namely, the primary, the secondary, and the tertiary health care. The primary health-care system, which is linked to the local government, facilitates health-care delivery at the grassroot, through rural health centers often without in-patients care. Patients who require admission at the rural health center are referred to the secondary health centers or other specialized institution. The secondary health-care level is an important level, which caters for most diseases and health problems which are not complicated. It is an intermediate health-care system between the primary and the tertiary health system, which caters for a wide range of medical services. The tertiary health centers, on the other hand, cater for highly select population; mostly complicated diseases and health state and serve as a research and training center. Morbidity and mortality patterns among medical admissions in a Nigerian secondary health-care hospital has been previously studied as well as a review on blood pressure, prevalence of hypertension and hypertension-related complications in Nigerian Africans.[5],[9] However, data are sparse on the trend of cardiovascular diseases, particularly among the female gender in sub-Saharan Africa.

The study, therefore, aims to determine the trend of cardiovascular diseases among medical admissions in a public secondary health-care center with a focus on the female gender.


  Materials and Methods Top


The study is a retrospective review of the trend of cardiovascular diseases using the medical admission records of all patients admitted to the medical wards of Adeoyo State Hospital, a 274-bedded public secondary health-care center, over a 5-year period, 1997–2001. The hospital, which subserves Ibadan and environ, is located in the south-west of Nigeria, Ibadan, the largest city in West Africa and second largest in Africa. It is well equipped with staff and infrastructure. The sources of medical admissions are from the general outpatient where any patient can walk in or referrals from peripheral hospitals and the primary health-care centers to the medical outpatient clinics. The hospital has two medical wards, one for male patient and the other for female patients, each with an adjoining small ward for infectious disease patients or those patients who require isolation. The wards are equipped with 52 beds, with a male-to-female ratio of 1:1 into the appropriate wards. The children's hospital is about 5 km away from this hospital. Some of these children may be admitted to the adult medical wards owing to pressure of beds in the pediatric wards.

The data were extracted from the hospital records using a data collection form that included the hospital number, patients' age, gender, and principal diagnosis. Other information obtained were the date of admission, outcome of admission, and date of outcome. Permission was obtained for the study from the Ministry of Health and Hospitals Management Board Ethical Review Board.

Statistical analysis

Data were analyzed on a microcomputer using the SPSS version 11 (SPSS Inc., Chicago, IL, USA) for data entry and statistical analysis that included time series trend. Proportions and percentages were used to summarize qualitative data while means, median, and standard deviation for quantitative data. Student's t-test and Mann–Whitney U-test, for skewed data, were used to test the significance of differences between two mean and median values, respectively. The significance of association between any two qualitative variables was investigated by Chi-square test. All tests were at the 5% level of statistical significance.


  Results Top


Between the years 1997 and 2001, 2474 patients were admitted to the medical wards. Of these 912 (37.0%), with a mean age of 54.9 (14.6) years had cardiovascular disease, 51.3% were females. Mean duration of hospital stay was 11.8 (9.1) days, range 1–90 days, and median 10 days. Hypertension and hypertension-related complications constituted over 90% of cardiovascular diseases, 39% had a congestive cardiac failure, whereas 28% had cerebrovascular diseases. Ischemic heart disease and cardiomyopathies occurred in <1% of the patients. The pattern of morbidity and mortality is shown in [Table 1]. Frequency of cardiovascular diseases significantly increased among female patients by about 330% during the study period from 1997 to 2001, a period of 4 years and by 140% in the male patients; 47 (1.9%) to 155 (6.3%) versus 80 (3.2%) to 113 (4.6%), respectively, P = 0.003. [Figure 1] shows the trend of cardiovascular diseases, whereas [Figure 2] shows the gender distribution. Overall mortality rate was 155 (17%) for cardiovascular diseases which was higher among males (86, 55.5%) compared to the female patients though not statistically significant, P = 0.063.
Figure 1: The time series trend of cardiovascular diseases among medical admissions

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Figure 2: Gender distribution of cardiovascular diseases between 1997 and 2001 among medical admissions P = 0.003

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Table 1: Morbidity and mortality pattern of cardiovascular diseases between 1997 and 2001

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  Discussion Top


In this study, the finding that cardiovascular diseases are responsible for over a third of medical admissions may be consistent with the global increase in the burden of cardiovascular diseases, particularly in the less developed countries.[10] This demands a pragmatic approach for a rapid containment of an imminent epidemic. The middle-age group, constituting nearly half of the patients affected by cardiovascular diseases, form a bulk of the working class. This could have attendant economic implications. Hypertension was the most common cardiovascular disease. There is a need to control this with primary prevention, early detection, and treatment.[11] There was a drop in the trend about a decade ago, in 1998, with a subsequent significant rise which also coincided with a significantly higher increase in females. Targeted gender research and control programs may help to curtail the increasing trend of cardiovascular diseases in women.[12] There may be subtle, but important differences in how women's cardiovascular system responds to stress, hormones, and other risk factors. It has also been suggested that while the stress hormones go down in men on returning home from work, it goes up in women who are faced with cooking, housework, and childcare. It may also be important to revisit research into premenopausal hormonal protection against heart disease. Surveillance for cardiovascular diseases at every available opportunity in women should be put in place. Control program to curtail cardiovascular disease in women could be incorporated into antenatal and postnatal visits.

Ischemic heart disease and cardiomyopathies were not common, about 1% of cardiovascular diseases in this study. Coronary heart disease though affirmed to have increased over the years was still relatively uncommon as at this time and has not significantly contributed to cardiovascular disease morbidity and mortality.[13]


  Conclusion Top


Cardiovascular diseases are on the increase among female patients, however, they may be surviving this more than their male counterparts.

Acknowledgment

The permanent secretary, Dr. Bello; Director of Medical Services, Dr. Adejokun; and the medical and records staff are appreciated for their kind assistance. Dr. Omowunmi Osinubi assisted with the editing of the manuscript and presented the abstract at the American Society of Tropical Medicine and Hygiene 56th Annual Meeting Philadelphia, Pennsylvania, USA, November 2007.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Dominguez LJ, Galioto A, Ferlisi A, Pineo A, Putignano E, Belvedere M, et al. Ageing, lifestyle modifications, and cardiovascular disease in developing countries. J Nutr Health Aging 2006;10:143-9.  Back to cited text no. 1
[PUBMED]    
2.
Rosmarakis ES, Vergidis PI, Soteriades ES, Paraschakis K, Papastamataki PA, Falagas ME, et al. Estimate of global production in cardiovascular disease research. Int J Cardiol 2005;100:443-9. Available: https://www.ncbi.nlm.nih.gov/pubmed/15837089. [Last accessed on 2017 Jul 13].  Back to cited text no. 2
    
3.
Rahman Al-Nuaim A. High prevalence of metabolic risk factors for cardiovascular diseases among Saudi population, aged 30-64 years. Int J Cardiol 1997;62:227-35.  Back to cited text no. 3
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4.
Olatunbosun ST, Kaufman JS, Cooper RS, Bella AF. Hypertension in a black population: Prevalence and biosocial determinants of high blood pressure in a group of urban Nigerians. J Hum Hypertens 2000;14:249-57.  Back to cited text no. 4
[PUBMED]    
5.
Adedapo AD, Fawole O, Bamgboye AE, Adedapo K, Demmisie K, Osinubi O. Morbidity and mortality patterns of medical admissions in a Nigerian secondary health care hospital. Afr J Med Med Sci 2012;41:13-20.  Back to cited text no. 5
    
6.
Marshall WA. Demographic changes and the need for health technologies. J R Soc Health 1983;103:207-9.  Back to cited text no. 6
    
7.
Taggart DP. In controversies in cardiology. Lancet 2006;367:1313.  Back to cited text no. 7
    
8.
Ogunmekan GO. Analysis of medical admissions to Adeoyo State Hospital, Ibadan, 1969. Niger Med J 1973;3:5-12.  Back to cited text no. 8
    
9.
Ogah OS, Okpechi I, Chukwuonye II, Akinyemi JO, Onwubere BJ, Falase AO, et al. Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review. World J Cardiol 2012;4:327-40.  Back to cited text no. 9
    
10.
He FJ, de Wardener HE, MacGregor GA. Controversies in cardiology. Lancet 2006;367:1313-4.  Back to cited text no. 10
    
11.
Gyarfas I. Lessons from worldwide experience with hypertension control. J Hum Hypertens 1996;10 Suppl 1:S21-5.  Back to cited text no. 11
    
12.
Lerman A, Sopko G. Women and cardiovascular heart disease: Clinical implications from the Women's Ischemia Syndrome Evaluation (WISE) Study. Are we smarter? J Am Coll Cardiol 2006;47 3 Suppl:S59-62.  Back to cited text no. 12
    
13.
Nwanelli CU. Changing trend in coronary heart disease in Nigeria. Afrimedic 2010;1:1-4.  Back to cited text no. 13
    


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