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Cardiovascular disease (CVD) is a group of non-communicable diseases that affect the heart and the blood vessels. It is a significant health issue that affects people at their productive ages worldwide (Ekinci, 2023; Soares, 2023). A lot of diseases fall under CVDs. They include; Coronary Heart Disease, Cerebrovascular Disease, Peripheral Arterial Disease, Rheumatic Heart Disease, Congenital Heart Disease, Deep Vein Thrombosis and Pulmonary embolism  (World Health Organization, 2021). Symptoms of these diseases vary widely depending on the particular type of disease. In some cases, no symptom is shown. Notable symptoms include; chest pain, hypertension, shortness of breath, heart attack etc. Coronary Heart Disease or coronary artery disease (CAD) is a disease that occurs when there is problem with the supply of oxygenated blood to the heart. Fatty substances called atheroma builds up with time in the coronary arteries (in a process called Atherosclerosis), thus causing some restriction in blood flow. In Cerebrovascular disease, the flow of blood to the brain is restricted. This restriction can be temporal (Transient Ischemic Attack - TIA), a total blockage (stroke), arterial walls may also be weakened resulting in a bulge or distensions (aneurysm) or some vascular malformation. In recent years, Stroke is a leading cause of death affecting people of all gender globally. According to US National centre for health statistics, cerebrovascular disease is ranked the 5th most common cause of death in the United States (Fast stats). Peripheral arterial disease (PAD) affects the blood vessels supplying blood to the arms and legs. This is more common in the legs than arms and obvious symptom include a leg pain during some physical activities that gets better after some rest. Patients living with PAD have a high risk of developing coronary heart disease or cerebrovascular disease. Rheumatic Heart disease (RHD) is a disease that occurs due to high exposure to Streptococcus A. Complications can damage the heart valves while Congenital Heart disease is a heart abnormality present at birth. According to Dass and Kanmanthareddy (2023), RHD is a very critical form of heart disease found in children and young adults in developing country regions. In 2015, the incidence is high in Oceania, South Asia and sub-Saharan Africa (Watkins et al., 2015). Deep vein thrombosis occurs when there is a blood clot causing blockage in deep veins while Pulmonary embolism occurs when there is a blood clot causing blockage in pulmonary artery (WHO 2021). 

CVDs have caused a lot of death and contributed to disability for years globally (Rezaianzadeh et al., 2023). In 2019, CVD constituted 32% of all global deaths at an estimate of 17.9 million. 85% of these deaths resulted from heart attacks and strokes (Ekinci, 2023). The 2023 world heart report by the world heart federation estimated an increase of CVD mortality from 12.1 million in 1990, which were distributed equally between males and females to 18.6 million in 2019, with unequal distribution. This estimate increased to 20.5 million in 2021 despite measures that has been long implemented to control it.  While it increased, there has been a notable fall in age-standardization death rate (ASMR) in recent years (World Heart Federation, 2023). This is great news, however, the decline isn't consistent across regions. It declined faster in high income countries than low and middle income countries (LMIC) and that may be because of poor access to healthcare resources which is prevalent in LMIC. High-income countries have adequate funding that supports their healthcare unlike LMIC. Risk factor distribution across regions may also be a contributing factor. Oceania, South Asia, Southeast Asia, East Asia and sub-Saharan African regions showed observable slowest decline rate in them. WHO stated that out of the 17 million premature deaths due to non-communicable diseases reported from people under the age of 70years, 86% are from low and middle-income countries, and 38% are caused by cardiovascular diseases (WHO, 2021; WHO, 2023). Aside these variations across regions, research has revealed variations across age groups, ethnicity, socio-economic status and sex also. In the study done by Hasani et al. (2023) on the global estimate of premature CVD death, he reported that death due to CVD is higher in males than females. This supports the report from world heart federation (2023) that age standardization CVD mortality rate is dominant in males than females worldwide, though inconsistency across regions exists. Individual countries must fully take note of all these factors in their efforts of improving cardiovascular health of the people so that they can make suitable policies. 

Cardiovascular diseases can be caused by a variety of risk factors which vary across populations. The factors center on socio economic, metabolic, behavioural and environmental factors. Some can be controlled (modifiable) while some cannot (non modifiable). Non modifiable risk factors include; age, family history, race, gender while the modifiable risk factors include; high blood pressure, unhealthy diet, high cholesterol, diabetes, air pollution, obesity, tobacco use, kidney disease, physical inactivity, harmful use of alcohol and stress (Rezaianzadeh, 2023). Every population have different risk factors prevalent in their region depending on their environment and their lifestyles, be it exposure to air pollution, high blood pressure, high sodium intake, alcohol and tobacco usage or physical activity levels. E.g., high sodium consumption and high blood sugar was prevalent in Southeast Asia, East Asia, and Oceania regions while exposure to air pollution was significant among the south Asians (World Heart Federation, 2023). Risk factors peculiar to the African region include hypertension causing 19% of world death, raised blood sugar, overweight, tobacco (27%) and alcohol consumption (25%) (Gouda et al., 2019). Also, different CVD types have lifestyles which increase the risks of having them e.g. Excess intake of alcohol and smoking improves risk of atherosclerosis. Stroke can develop from atherosclerosis or thrombosis. Risk factors of stroke include hypertension, smoking, diabetes, diet, age, family history, race, gender, sedentary lifestyle, history of stroke, TIA, obesity, heart attack, high blood cholesterol, artery disease, PAD, sickle cell diseases and atrial fibrillation (American Stroke Association, 2021a, American Stroke Association, 2021b). Of the non-modifiable factors, history of heart disease and age are critical. There are higher risks in people that are up to 70 years of age than lower. Regardless, modifiable risk factors have been identified to cause 90% of all strokes (Hankey, 2020). Risk factors of PAD involve tobacco usage, smoking, high blood pressure, high cholesterol, diabetes, age above 60 yrs and artherosclerosis (Gerhard-Herman et al., 2017). Whatever the risks, policies to combat them should be set and enforced.

There are few data on the intervention strategies put forward to manage rate of CVD death in Nigeria. However, there are regional efforts like the Pan-African Society of Cardiology (PASCAR) goal to achieve a 25% reduction in the prevalence rate of raised blood pressure in Africa. This is a good initiative since hypertension rate is very high in the region. There is also the WHO framework convention of Tobacco control that helps to implement the control of tobacco usage in the region. Globally, there are lots of interventions set. The United Nations set targets in 2015 to help reduce the rate of death from CVD by 33% by 2030. The WHO response includes a global plan made by its member states that aimed towards reducing premature deaths resulting from NCDs by 25% by the year 2025 (WHO, 2021). The targets that involved CVD reduction include the plan to reduce hypertension rate by 25% since raised blood pressure is an identifiable risk factor of CVD, the plan which proposes reception of treatment and counselling, including blood sugar control by at least 50% eligible people so as to prevent heart attacks and strokes (Minja et al., 2022). Other initiatives involved tackling the issue at population level e.g., WHO PEN initiative, Global Hearts initiatives by the United States Center for Disease Prevention and Control and partners, Resolve to save lives (focuses on tobacco and alcohol consumption and physical activities), 2021 WHO guidelines on pharmacological treatment of high blood pressure and the European guidelines on CVD prevention in clinical practice developed by European Society of Cardiology to support healthcare professionals in their efforts towards reducing the burden of Atherosclerotic cardiovascular diseases in population level and in individual patients (WHO, 2023b p.60). Regional targets constitute diagnosis of not less than 80% of adults living with hypertension and treating at least 64% of those that were diagnosed. These are all good policies but when not enforced becomes as good as nothing. For regions like Africa where there is no quality healthcare services, implementing these policies to achieve desirable results might be unattainable.

It is no longer news that cardiovascular diseases have become a public health problem of the modern era. There have been worldwide reports and interventions on CVD but despite years of scientific innovations and advancement dedicated towards reducing CVD prevalence globally, there are still regular reports of people with incidence of heart attacks and strokes (CDC, 2024). Some die from them while some survive. According to Center for Disease Prevention and Control (CDC), at least one person suffers a heart attack every fourty seconds in the United States and at least one person dies every 33 seconds from cardiovascular disease. The real fact is that cardiovascular events can be prevented if some caution is taken. Yet, despite being endowed with this knowledge, many people still don’t get to receive these preventive measures. The underprivileged are mostly affected since they don’t get diagnosed on time. All these and more constitute the challenges facing the public health care and this is hindering successful management of CVDs particularly in low and middle-income countries. In Africa, there are poor outcomes associated with adequate access to public health care. Disease burden in the region used to be largely attributed to infectious and communicable diseases. However, there has been transition in epidemiology and demographics. Rapid urbanization has influenced peoples way of living, nutritional habits, and stress levels. Low health literacy isn’t helping the trend either. Today, African region now experiences a high burden of non-communicable diseases, mainly CVDs, thus making the region face a double burden of both infectious and non-communicable diseases (Stower, 2019; Obonyo et al., 2023). This transition places a great burden on the public health. In 2019, World Health Organization estimated 1,093,577 deaths from CVD in the African region compared to 17,900,000 global CVD deaths. In West Africa (Algeria inclusive), the estimated CVD death was 428,455 with Nigeria having the highest estimate at 146,627 CVD deaths (WHO, 2023b). Nigeria as a middle-income African country and the most populated in the region (over 200 million) is not exempted (Ogah, Orimolade and Jinadu, 2023). Health outcomes are very poor and there is a lower life expectancy in Nigeria (54 years) compared to neighbouring countries in the same continent. Investment in health is also very poor at 4% of GDP in 2018 (Abubakar et al., 2022). Healthcare challenges center around insufficient health infrastructures and health professionals. Also, there’s limited diagnostic and treatment services available. There is high rate of poverty too. As a result, there is need for collaborations among governments, NGOs, and well to do civilians in order to adequately fund the healthcare so as to improve the health of the people. Psychological intervention is also necessary so as to help patients face their conditions without fear, anxiety or depression while intervention strategies that focus on health education is also encouraged as this will help to promote healthy lifestyle behaviours among the people. 

 In conclusion, CVD places a great burden and challenge to public health globally. Identifying the risk factors peculiar to a region or individual CVD is a must as this will help policy makers to make the right initiative that will help to improve cardiovascular health and in turn reduce the rate of CVD death globally.

 

Abubakar, I., Dalglish, S. L., Angell, B., Sanuade, O., Abimbola, S., Adamu, A. L., Adetifa, I. M. O., Colbourn, T., Ogunlesi, A. O., Onwujekwe, O., Owoaje, E. T., Okeke, I. N., Adeyemo, A., Aliyu, G., Aliyu, M. H., Aliyu, S. H., Ameh, E. A., Archibong, B., Ezeh, A., Gadanya, M. A and Zanna, F. H. (2022) ‘The Lancet Nigeria Commission: investing in health and the future of the nation’, Lancet (London, England), 399(10330), pp.1155–1200. doi: https://doi.org/10.1016/S0140-6736(21)02488-0

American Stroke Association. (2021). Risk factors not within your control. Available at: <https://www.stroke.org/en/about-stroke/stroke-risk-factors/stroke-risk-factors-not-within-your-control> (Accessed 5 March 2024)

American Stroke Association (ASA) 2021. Risk factors within your control. Available at: <https://www.stroke.org/en/about-stroke/stroke-risk-factors/stroke-risk-factors-within-your-control> (Accessed 5 March 2024)

Center for Disease Prevention and Control. Heart disease facts. Available at: <https://www.cdc.gov/heartdisease/facts.htm> (Accessed 5 March 2024)

Dass C. and Kanmanthareddy A. (2023) ‘Rheumatic heart disease’ in StatPearls. Treasure Island (FL): StatPearls.  doi: https://www.ncbi.nlm.nih.gov/books/NBK538286/

Ekinci G. (2023) ‘Economic impacts of cardiovascular diseases: an econometric evaluation in Turkey’ Iranian journal of public health, 52(1), 118–127. doi: https://doi.org/10.18502/ijph.v52i1.11673

FastStats (no date). Leading causes of death. Available at: < https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm> (Accessed: 4 March 2024)

Gerhard-Herman, M.D., Gornik, H.L, Barrett, C., et al. (2016) ‘AHA/ACC Guidelinee on the management of patients with lower extremety peripheral artery disease: executive summary: a report of the American college of cardiology/American heart association task force on clinical practice guidelines’, Circulation,135(12):e686-e725.

Gouda, H., Charlson, Fiona, Sorsdahl, Katherine, Ahmadzada, Sanam , Ferrari, Alize, Erskine, Holly, Leung, Janni, Santamauro, Damian, Lund, Crick, Aminde, Leopold, Mayosi, Bongani, Kengne, Andre, Harris, Meredith, Achoki, Tom, Wiysonge, Charles, Stein, Dan, Whiteford and Harvey. (2019) ‘Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the global burden of disease study 2017’, The Lancet. Global health. 7. e1375-e1387. doi: https://doi.org/10.1016/S2214-109X(19)30374-2.

Hankey G. J. (2020) ‘Population impact of potentially modifiable risk factors for stroke’, Stroke, 51(3), 719–728. doi: https://doi.org/10.1161/STROKEAHA.119.024154

Hasani, W. S. R., Muhamad, N. A., Hanis, T. M., Maamor, N. H., Chen, X. W., Omar, M. A., Cheng Kueh, Y., Abd Karim, Z., Hassan, M. R. A., and Musa, K. I. (2023) ‘The global estimate of premature cardiovascular mortality: a systematic review and meta-analysis of age-standardized mortality rate’, BMC public health, 23(1), 1561. doi: https://doi.org/10.1186/s12889-023-16466-1

Macarayan, E. K., Gage, A. D., Doubova, S. V., Guanais, F., Lemango, E. T., Ndiaye, Y., Waiswa, P., and Kruk, M. E. (2018) ‘Assessment of quality of primary care with facility surveys: a descriptive analysis in ten low-income and middle-income countries’, The Lancet. Global health, 6(11), e1176–e1185. doi: https://doi.org/10.1016/S2214-109X(18)30440-6

Minja, N. W., Nakagaayi, D., Aliku, T., Zhang, W., Ssinabulya, I., Nabaale, J., Amutuhaire, W., de Loizaga, S. R., Ndagire, E., Rwebembera, J., Okello, E., and Kayima, J. (2022) ‘Cardiovascular diseases in Africa in the twenty-first century: gaps and priorities going forward’, Frontiers in cardiovascular medicine, 9, 1008335. doi: https://doi.org/10.3389/fcvm.2022.1008335

Obonyo, N. and Etyang, A. (2023) ‘Cardiovascular health priorities in sub-saharan Africa’, SN Comprehensive Clinical Medicine. 5. doi: https://doi.org/10.1007/s42399-023-01605-x.

Ogah, O.S, Orimolade, O.A and Jinadu, T..O. (2023) ‘Cardiovascular diseases in Nigeria: current status, threats, and opportunities’, Circulation, 148:1441–1444 doi: https://doi.org/10.1161/CIRCULATIONAHA.123.063671

Rezaianzadeh, A., Moftakhar, L., Seif, M. et al. (2023) ‘Incidence and risk factors of cardiovascular disease among population aged 40–70 years: a population-based cohort study in the south of Iran’, Trop Med Health 51, 35 doi: https://doi.org/10.1186/s41182-023-00527-7

Roth, G. A., Mensah, G. A., Johnson, C. O., Addolorato, G., Ammirati, E., Baddour, L. M., Barengo, N. C., Beaton, A. Z., Benjamin, E. J., Benziger, C. P., Bonny, A., Brauer, M., Brodmann, M., Cahill, T. J., Carapetis, J., Catapano, A. L., Chugh, S. S., Cooper, L. T., Coresh, J. and Criqui, M. (2020) ‘Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study’, Journal of the American College of Cardiology, 76(25), 2982–3021. doi: https://doi.org/10.1016/j.jacc.2020.11.010

Soares, L. Leal, T., Faria, A., Aguiar, A. and Carvalho, C. (2023) ‘Cardiovascular disease: A Review’, Biomedical Journal of Scientific & Technical Research. 51. doi: https://doi.org/10.26717/BJSTR.2023.51.008101

Stower H. (2019) ‘A Disease transition in sub-saharan Africa’, Nature medicine, 25(11), 1647.doi: https://doi.org/10.1038/s41591-019-0659-0

World Health Organization (2021). Cardiovascular diseases (cvds). Available at: <https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)> (Accessed: 4 March 2024)

World Health Organization (2023a). Non communicable diseases. Available at: <https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases-(cvds)> (Accessed: 4 March 2024)

World Health Organization. (2023b). The communicable and non communicable disease burden in Africa in 2021/2022. p60. Available at  <https://www.afro.who.int/sites/default/files/2023-08/Disease%20outlook%20report_BLF_revised_190823_AHN.pdf> (Accessed: 4 March 2024)

World Heart Federation (2023). World heart report 2023: Full report. Available at: <https://world-heart-federation.org/resource/world-heart-report-2023/> (Accessed: 4 March 2024)