title: Impact of income on the profile of cardiovascular risk factors among hypertensives in a Nigerian tertiary health centre: a cross-sectional study.
abstract: BACKGROUND
  In most developed countries, risk factors for cardiovascular diseases (CVD) are more prevalent in low socioeconomic classes. However, the pattern in developing countries appears to be different. This study sought to evaluate and compare risk factors for CVD as well as absolute CVD risk in hypertensive subjects grouped by income in Kano, Nigeria.
  
  
  METHODS
  The study was cross-sectional in design and carried out in Aminu Kano Teaching Hospital, Kano, Nigeria. Seventy treatment-naïve hypertensives and an equal number of hypertensives on treatment were recruited by balloting from the outpatient clinics, and then regrouped into low- and high-income earners. These two groups were then compared in terms of their profile of CVD risk factors and absolute CVD risk. All the assessed CVD risk factors are recognised in standard guidelines for the management of persons with systemic hypertension.
  
  
  RESULTS
  The low-income group comprised 45 patients (32.1%) while the remaining 95 (67.9%) had a high income. The most prevalent CVD risk factor was dyslipidaemia, found in 77.8 and 71.6% of low- and high-income earners, respectively (p = 0.437). The prevalence of proteinuria was significantly higher among low-income earners (42.2%) compared with high-income earners (15.8%) (p = 0.001). Mean serum creatinine was also higher among low-income earners but the difference did not reach statistical significance (p = 0.154). Very high CVD risk was found in 75.6 and 70.5% of low- and high income earners, respectively (p = 0.535).
  
  
  CONCLUSIONS
  Dyslipidaemia and very high CVD risk were found in over 71% of the patients regardless of their level of income. Low-income earners had a higher prevalence of indices of renal damage. These findings pose a great challenge to the present and future management of all subjects, particularly those in the low-income group, given that in Nigeria, healthcare is largely paid for directly out of their pockets.
authors.affiliation: Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria. kkaraye@yahoo.co.uk
authors.forename: K M
authors.initials: KM
authors.lastname: Karaye
authors.forename: B N
authors.initials: BN
authors.lastname: Okeahialam
authors.forename: S S
authors.initials: SS
authors.lastname: Wali
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology; D007182:Income; D016015:Logistic Models; D009549:Nigeria / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D003404:Creatinine
references.citation: Circulation. 2001 Nov 27;104(22):2746-53
references.pmid: 11723030
references.citation: Cardiovasc J Afr. 2007 Sep-Oct;18(5):290-4
references.pmid: 17957322
references.citation: J Postgrad Med. 2002 Jul-Sep;48(3):206-8
references.pmid: 12432198
references.citation: Ann Epidemiol. 1996 Jul;6(4):290-8
references.pmid: 8876839
references.citation: J Hypertens. 2003 Nov;21(11):1983-92
references.pmid: 14597836
references.citation: N Engl J Med. 2008 Jun 5;358(23):2468-81
references.pmid: 18525043
references.citation: Cardiovasc J Afr. 2007 Mar-Apr;18(2):77-83
references.pmid: 17497043
references.citation: Niger J Med. 2007 Apr-Jun;16(2):119-24
references.pmid: 17694763
references.citation: Niger J Med. 2008 Jul-Aug;17(3):350-5
references.pmid: 18788267
references.citation: Cardiovasc J Afr. 2007 Sep-Oct;18(5):316-20
references.pmid: 17957321
references.citation: Nephrol Dial Transplant. 2008 Jul;23(7):2365-73
references.pmid: 18234844
references.citation: Lancet. 2004 Sep 11-17;364(9438):937-52
references.pmid: 15364185
references.citation: J Clin Lipidol. 2008 Aug;2(4):274-8
references.pmid: 21291743
references.citation: Blood Press Suppl. 1999;1:9-43
references.pmid: 10401540
references.citation: CMAJ. 2008 Nov 18;179(11):1154-62
references.pmid: 19015566
references.citation: Br Med J. 1978 Oct 21;2(6145):1109-12
references.pmid: 709255