Prevalence and Risk Factors of Cardiovascular Diseases among the Nigerian Population: A New Trend among Adolescents and Youths

Abstract

This chapter gives an overview of the prevalence and risk factors of cardiovascular diseases (CVDs) among Nigerian population with emphasis on the younger population. The Nigerian population is largely dominated by youths who contribute significantly toward economic growth of the country. Addressing the issues of cardiovascular diseases among this population offers an opportunity toward increasing life expectancy and building a healthy nation. In order to understand the issues at hand, this chapter detailed the prevalence of cardiovascular diseases among youths, and it also identifies the risk factors that contribute to the development of CVDs among the population. Furthermore, it gave recommendations on how the issue of CVDs among the younger population can be addressed.

1. Introduction

Cardiovascular diseases (CVDs) are a group of illnesses that mostly affect the heart and blood vessels. They are the major causes of death and disability worldwide, particularly in low- and middle-income nations [1, 2]. CVDs claimed the lives of an estimated 17.9 million individuals in 2019, accounting for nearly 32% of all worldwide fatalities that year [1]. Even more concerning was the fact that three-quarters of these deaths occurred in low- and middle-income nations, such as sub-Saharan Africa (SSA), which also supplied 80% of the global illness burden [1, 3]. Not only is the present mortality, prevalence, and disability associated with CVDs great, but there is also an increasing tendency, making future estimates much bleaker than the current scenario. Roth et al. [2] estimated an almost doubling of the global prevalence of CVDs from 1990 to 2019 in their synthesis of data from the Global Burden of Disease 2019 Study. Similarly, the number of fatalities (from 12.1 million in 1990 to 18.6 million in 2019) and years lived with disability (from 17.7 million in 1990 to 34.4 million in 2019) nearly doubled during the same time [2]. Cardiovascular diseases (CVDs) affect 31% of all people globally. The underlying pathology is a lifetime process that begins in childhood and develops throughout adolescence depending on risk factors. Identifying and treating risk factors in teenagers allow for the management of CVDs [4].

The existence of risk factors considerably influences the development of CVD [5]. In emerging nations, the prevalence of CVD has risen among younger individuals aged 25–44 years, who make up the working population, compared to the older population of persons aged 65 years and older in industrialized countries [6]. This shift has been connected to an increase in harmful lifestyle characteristics such as poor food, inactivity, smoking, and alcohol consumption [7]. CVD risk factors are frequently formed during infancy and adolescence and become established in adulthood [8]. As a result, early detection of its risk throughout infancy and adolescence may help avoid or postpone the beginning of CVD [9]. Adolescents aged 10–19 years [10] experience changes in their social surroundings and social lives as they transition to adulthood. This is visible as they fail to develop regular eating and sleeping routines, resulting in a lack of exercise, bad dietary habits, weight gain, and insufficient sleep [11]. CVD and related risk factors are predicted by socioeconomic level (SES). However, the degree of this relationship changes depending on the countries’ economic progress [12, 13]. In high-income nations, regardless of the SES measures utilized, evidence suggests to a negative connection between SES and CVD risk factors in the adult population [14]. This tendency contrasts in low-middle-income nations and among people with lower socioeconomic status in developed countries, where lower socioeconomic status is a possible predictor of worse health outcomes [15].

Inadequate general community understanding of CVD and its risk factors is a barrier to successful CVD prevention and treatment [16]. As a result, understanding CVD knowledge gaps and perceptions among teenagers is critical to developing a CVD preventive program for this subpopulation [17]. It has been demonstrated that increased understanding of an illness and propensity to it improves adherence to lifestyle adjustments [18]. Knowledge of CVD and its risk factors is critical for both primary and secondary CVD prevention [19]. At least one in every three teenagers and young adults has insufficient health literacy and, as a result, engages in unhealthy behaviors [19]. Good CVD knowledge and comprehension will lead to better health-seeking behavior, which will affect CVD preventive and control judgments and decisions [20, 21]. Cardiovascular disease imposes a massive economic burden because of its impact on the working population and the high expense of its treatment [22]. CVD prevention is thus the ideal option for a growing country like Nigeria. The goal of this study is to investigate the prevalence and risk factors for CVD among Nigerian adolescents and youths.

2. Types of cardiovascular diseases

There are few surveys on the prevalence of cardiovascular diseases in among Nigerian adolescents. In urban Nigeria, there has been a rising prevalence of hypertension [23]. A 150% increase in the prevalence of cardiovascular disease has also been reported [24]. Hypertension affects up to 46% of Nigerian adults and a rising proportion of Nigerian adolescents [25, 26]. Furthermore, Adedapo et al. [24] reported in a research study that cardiovascular diseases are fully account for more than a 30% of medical admissions, which is in tandem with the sharp rise in the burden of cardiovascular diseases, especially in developing countries [27]. This necessitates a realistic approach to the swift deterrence of an impending epidemic. The middle-aged group who account for nearly half of all cardiovascular disease patients form a sizable portion of the workforce driving the Nigerian economy. Given that biological changes occur at a faster rate throughout childhood and adolescence than at any other time in life, it is acceptable to consider this age group to be an important category for examining CVD risk factors [28]. Adedapo [29] observed hypertension to be the leading cardiovascular disease among medical outpatients in a study in southwestern Nigeria. Ischemic heart disease and cardiomyopathies were entirely unusual, accounting for less than 1% of all cardiovascular diseases in the study.

Also, coronary heart disease (CHD), despite being acknowledged to have ramped up in recent time, is still exceptionally rare and has not made a major contribution to cardiovascular mortality rates [30]. Female patients presenting with cardiovascular disease are becoming increasingly prevalent; however, their survival odds are greater than that of males [29]. The most predominant CVDs over the previous half-century were rheumatic heart disease and cardiomyopathies; however, hypertension, rheumatic valvular disease, and cardiomyopathy overtook and became the leading causes of CVDs in the recent decade [30, 31, 32, 33, 34]. Hypertension, coronary heart disease (CHD), stroke, hypertensive heart diseases, arrhythmias, heart failure, cardiomyopathies, valvular heart diseases, and congenital heart disorders are among the cardiovascular diseases of high significance (Table 1) [36].

S/N	Types of CVDs	Description	Symptoms	Risk factors
1	Coronary heart diseases	Ischemic heart disease (IHD)	Heart attack Angina at chronic condition	High blood pressure/blood cholesterol (BC), smoking, unhealthy diet, physical inactivity, diabetes, and aging
2	Stroke	Ischemic stroke Hemorrhagic stroke Transient ischemic attack	Brain damage resulting into sudden injuries Weakness often on one side of the body	High, tobacco use, unhealthy diet, physical inactivity, diabetes, and aging
3	Rheumatic heart disease	Inflammation of the heart valves and heart muscle	Shortness of breath, fatigue, irregular heartbeats, chest pain and fainting.	—
4	Congenital heart disease	Malformations of heart or central blood vessel at birth or during pregnancy	Breathlessness or a failure to attain normal growth and development	Maternal alcohol and medicines use; maternal infection (e.g. rubella) Poor maternal nutrition
5	Peripheral vascular disease	Atherosclerosis Abdominal aortic aneurysm		Persisting high BP Tangential heart disorders Syphilis, and other inflammatory disorders
6	Deep venous thrombosis (DVT) and pulmonary embolism	The blood clots in the veins, which can dislodge and move to the heart and lungs		Surgery, obesity, cancer, recent childbirth, use of contraceptives and hormone replacement therapy.
7	Other forms of cardiovascular diseases	Tumors of the heart Disorders of heart muscle (cardiomyopathy) Heart valve diseases

Table 1.

Types of cardiovascular diseases (CVDs), symptoms, and risk factors.

Behera et al. [35].

3. Demographic overview of youths and adolescents in Nigeria

Nigeria is the most populous country on the African continent and with a population of about 200 million, and it is the seventh largest in the world. Most of the population is young, with 42.54% between the ages of 0–14 years and half the population aged below 19 years. As a result, there is a very high dependency ratio in the country at 88.2 dependants per 100 non-dependants (Figure 1).

Figure 1.

The population pyramid of Nigeria, the large base representing the large number of young people in the country. Source: US Census Bureau International Data Base.

As a result of the large number of young people in the country, there exist specific health and social risks common among people in the early and developmental stage of life. Some of these risks include early pregnancy, sexually transmitted diseases, HIV/AIDS, alcohol and other drug abuse, cybercrime, social exclusion, and youth violence [37, 38]. Responding to all these issues, the Federal government of Nigeria developed a National Youth Policy, designed to address the needs of young people through five priority areas (globalisation, use of communication technology, impact of STDs/HIV/AIDS, and intergenerational issues and youth perpetrators of armed conflict) and thereby enhance youth lives [39].

4. Prevalence of CVD among adolescent

The incidence of risk factors for cardiovascular disease (CVD) is increasing in the world’s emerging countries. Worldwide, CVD accounts for the majority of chronic disease mortality [40], with low- and middle-income nations bearing more than 80% of the global CVD burden [41]. According to Oguoma et al. [42], the adult Nigerian population bears a significant burden of modifiable CVD risk factors. Diabetes was thought to be uncommon among Nigerians in the 1960s, with reported prevalence rates of 1% [43]. A few studies in various geopolitical zones of Nigeria found significant prevalence rates of diabetes and prediabetes among study participants. In Nigeria, the first case of prediabetes was reported in 1998 [44]. In a group of urban adults in Nigeria, they discovered a prevalence of 2.2%. In another study conducted in an urban area in Southern Western Nigeria, the overall prevalence of prediabetes was 3.3%, compared to a proven diabetic prevalence of 4.7% [44]. Another research in a remote Nigerian community discovered a diabetes incidence of 4.8% [45]. There is evidence that increased urban migration and urbanisation, which encourage lifestyle changes, contribute to an increase in the prevalence of these modifiable risk factors over time. It is also hoped that increased reporting will reveal the true prevalence of prediabetes and diabetes in Nigeria, particularly among seemingly healthy residents of rural communities.

Females were more obese than their male counterparts, either evaluated by overall obesity or central obesity. This is consistent with the reports of Ogunmola et al. [45] and Adegoke et al. [4] in Nigerian rural communities. In terms of diabetes and prediabetes, urban residents in the study were more obese than rural participants. Early data from Nigeria in the middle and late twentieth century suggested a low prevalence of obesity [46, 47]. In today’s world, more areas are becoming urbanised, encouraging sedentary lifestyles and unhealthy eating. Farming and trading are the primary occupations of people living in rural areas, and they require a lot of physical activity. This contributes to their lower obesity prevalence when compared to their urban migrant counterparts. Our study also discovered a significant prevalence of prediabetes, hypercholesterolemia, central obesity, and low HDL in the 18–24 age group. A 10-year study of the incidence of cardiovascular disease risk factors discovered that the elevated risk in people with impaired fasting glucose was majorly driven by the presence of multiple CVD risk factors [48]. This is concerning in a context where procedures for early diagnosis and detection of disease risk factors are underutilized. It is debated that the effect of glucose-lowering drugs can postpone the progression of prediabetes to diabetes [49], but this can only be possible in societies with operational health systems, where people have adequate health care awareness and health-seeking behavior, which will improve the chances of early detection and intervention.

Studies in Nigeria have confirmed that there is variation in the prevalence of hypertension based on gender [50, 51]. Another study in Southeastern Nigeria backs up this finding, noting a high prevalence of hypertension and obesity CVD risks and complications, particularly in low-middle-income countries. Males are more likely than females to have had their blood pressure, blood glucose, and cholesterol levels checked. The reason for this occurrence was unknown. Ahaneku et al. [50] discovered that more females than males in their study had their blood pressure checked. Females are more likely than males to participate in health screening exercises, as observed in both our rural and urban populations. Several studies in Nigeria have found this trend [50, 51]. This could be explained by the characteristics of traditional African societies in which males are the primary breadwinners for their entire family and live in cities, while their wives and children live in villages [52]. Socioeconomic factors across the study population demonstrate that rural populations are more disadvantaged in terms of high-income earnings and post-secondary education. A higher proportion of participants in the rural setting are poor, as defined by the WHO as having an income of less than US$2 per day. The monthly minimum wage in Nigeria is 18,000 Naira, which is approximately US$109.80. In our study population, however, income status was not associated with a high prevalence of hypertension and dyslipidaemia (triglycerides, total cholesterol, and HDL). The high-income group was more diabetic and obese, but the differences between the lower and middle income groups were not statistically significant. Some studies conducted in Western countries found that people with lower incomes were more likely to be obese and diabetic [53, 54].

5. Risk factors for CVD among adolescents and youths

5.1 Unhealthy diets

A host of CVDs has been related to behavioral risk factors such as smoking, excessive alcohol intake, lack of physical exercise, and a high cholesterol diets, age and family history [55, 56]. According to Odunaiya et al. [17], poor dietary habits were widespread among Nigerian teenagers, with low fruit and vegetable intake leading the list, followed by high saturated fatty diets. The trend can be traced to western leisure standards adopted by the majority of the Nigerian populace, as well as major modifications in the quality, content, and quantity of meals consumed, particularly with the expansion of fast-food restaurants [57, 58, 59]. Furthermore, the CVD attributable risks at adolescence can either persist into adulthood or turn out to be a considerable predictor of future cardiovascular events, as studies [28, 60] have shown that CVD has its foundations in childhood and adolescence, with variables linked to dietary choices and physical activity, being crucial antecedents of hypertension and obesity. Yilgwan et al. [61] observed high levels of obesity, physical inactivity, hypertension, and dyslipidemia in primary school children, with the pointers dominated by undernutrition. Diet has a significant impact in defining CVD risk factors, and consumption of a diet heavy in saturated fat, particularly palmitic acid, raises total cholesterol and LDL-cholesterol levels [62, 63].

Trans-fatty acids, which are found in relatively high concentrations in processed hydrogenated oils and dairy products common in Nigerian stores and markets, can increase CVD risk by increasing LDL cholesterol and decreasing HDL cholesterol [64]. According to Oguoma et al. [42], high alcohol intake can be connected with a statistically significant risk of hypertension. Similarly, Reynolds et al. [65] found that high alcohol use elevates the incidence of stroke in a meta-analysis. Alcohol intake in Nigeria was previously regulated by customs and traditions [66], but this has changed owing to changes brought about by economic development and westernization. Males are also more likely to consume alcohol than females, according to a WHO report, with 5% of males and 1% of females in Nigeria being regular alcohol consumers [67]. Major cooking oils in Nigeria are palm oil and groundnut oil, which are locally produced and sold at markets. Because these low-cost oils are widely available, people consume them regularly, which contributes to the rise in obesity, metabolic syndrome, and type 2 diabetes [68, 69]. Palm oils are produced locally, but foreign or well-processed groundnut oils, if accessible, are very costly [70].

According to WHO/FAO standards, saturated and monounsaturated fatty acid consumption must not surpass limits of 10% and 15–20%, respectively, to maintain proper total cholesterol levels and lower the risk of CVD [69, 71]. The consumption of fats and oils in Nigeria is an essential subject of research that must be investigated given the constantly growing occurrences of metabolic syndrome and diabetes in the populace.

5.2 Alcohol, tobacco, and other drugs

Harmful use of alcohol and tobacco smoking are established risk factors for the incidence of cardiovascular diseases [1], and studies have also found that all subgroups of recreational drugs are independently associated with a higher likelihood of heart diseases [72]. Over the years, research has found an association between heavy alcohol consumption and tobacco smoking with conditions and events such as hypertension, cardiomyopathy, ischemia, peripheral artery disease, and increased risk of hemorrhage in the blood vessels [73, 74, 75, 76]. However, the link between use of some drugs and cardiovascular diseases (CVDs) have not always been clear cut, and some researchers have identified that light to moderate consumption of alcohol might be a protective factor against some cardiovascular conditions like stroke [77]. The reason for this controversy is down to the fact that unlike in other scientific studies in which randomized control trials are the gold standard for concluding causation, it is impractical or even unethical in most cases to use a randomized control trial to investigate whether or not an association exists between drug use and cardiovascular diseases; hence, some uncertainty remains with respect to the causal relationship between some of these drugs, the volume consumed, and the incidence of CVD [78]. Tobacco smoking however has consistently been shown to be linked with heart diseases as seen in longitudinal and cross-generational studies like the British Doctor study and the Framingham Heart study [79, 80].

There has been a rise in CVD in developing countries like Nigeria, with a high mortality rate among young people than in developed countries [81], and this has been linked with both novel and traditional risk factors. One of which is the use of alcohol, tobacco products, and other drugs, which have been shown to be on an upward trajectory among youths in Nigeria, and statistics by the Nigerian Drug Law Enforcement Agency (NDLEA) estimates that about 40% of the country’s youths are deeply involved in the use of drugs, with alcohol as the most used substance and cannabis as the most commonly abused illicit drug [82]. The United Nations Office of Drug and Crime [83] has also established that the use of drugs among youths between the ages of 15 and 39 years in Nigeria is high and young people are initiated into use of illicit drugs like cannabis at an average age of 19 years. Using drugs from a young age is associated with poor health outcomes over the long term, and those youths who use four or more psychoactive substances have an increased risk of developing premature atherosclerotic cardiovascular diseases [72]. Although manifestations of CVD mostly occurs in adulthood, risk factors such as drug use develop during adolescence and youth, a critical stage of development, characterized by distinct physical, psychological, cognitive, and social changes [84]. The emergence of CVD among Nigerian adolescents and youths may reflect an increase in the volume and potency of drug use among young people. This increase as described by Dumbili [85] is a result of the normalization of drug use among young people in Nigeria.

The 2020 World Drug Report projects the use of drugs among young people to grow in the next decade [86], particularly in low- and middle-income countries, and this will pose more threats to the cardiovascular health of these youngsters. Fortunately, drug use is a modifiable risk factor; thus, it can be prevented and controlled by strengthening early detection [17] and modifying health behavior of young people through adequate health information and health promotion programs designed to improve young people’s knowledge and attitudes toward drug use and CVD prevention.

5.3 Genetics

There are multiple causes of cardiovascular diseases, but there is no uncertainty that genetic factors play a crucial role in their development (Table 2).

S/N	Category	Disease	Gene	Function
1	Congenital; Malformations	Atrial septal defect; Holt-Oram syndrome (holes between the atria)	NKX2–5; TBX5	Transcription factor Transcription factor
2	Cardiomyopathy	Familial hypertrophic; Cardiomyopathy; Idiopathic dilated; cardiomyopathy	β-Myosin; Troponin T; Troponin I; Cardiac myosin-binding; protein C; α-Tropomyosin; Actin; Dystrophin	Muscle contraction(forced generation) Muscle contraction (force transduction)
3	Cardiac arrhythmias	Long-QT syndrome; Idiopathic ventricular fibrillation; (Brugada syndrome); QT-related cardiac arrhythmia with sudden death	KLVQT1; HERG; mink; SCN5A; NOS1AP	Potassium channel Sodium channel The gene is the regulator of neuronal nitric oxide synthase, which modulates cardiac repolarization
4	Myocardial infarction	Early onset; Early onset	VAMP8; HNRPUL1	Platelet degranulation Encodes a ribonuclear protein
5	Heart failure	Congestive heart failure	KIF6 wild-type gene	Kinesin family member 6
6	Hypertension	Essential hypertension	AGT	Contraction of arterial smooth muscle
7	Blood lipid disorders	Familial hypercholesterolemia; Familial dyslipoproteinemias	LDL; ApoE	Regulation of low-density lipoprotein Regulation of plasma lipid concentrations
8	Atherosclerosis	Coronary artery disease; Coronary artery inflammatory disease	E-S128R; Interleukin-1 receptor; antagonist (IL-1ra) gene	Monitors white blood cell adhesion to the arterial wall IL-1ra is a potent natural mechanism for controlling IL-1 and inflammation

Table 2.

Genes that cause cardiovascular diseases.

Source: Kewal [87].

Cardiovascular diseases outcomes in a general population can be complicated by several genetic variables. The study of atypical mendelian types of variations, whereby mutations in single genes create dramatic outcomes, has proved extremely beneficial. These mutations provide a biological framework for understanding CVD development [88]. Mutations in genes that influence certain mechanisms have been found in families with inherited cases of hypertension or hypotension, both are caused by irregularities in the functioning of aldosterone synthase, and this has been observed to be an autosomal dominant trait which is characterized by hypertension, repressed renin activity, and abnormal aldosterone levels. This is induced by an unbalanced overlap between genes encoding enzymes of the adrenal-steroid biosynthesis pathway [89]. Hypertrophic cardiomyopathy is the most prevalent monogenic heart disorder and the leading cause of mortalities from cardiac abnormalities in children and adolescents, with an estimated 1 in 500 people suffering from the condition [90]. The heredity of hypertrophic cardiomyopathy is autosomal dominant in nature, and the condition is associated with mutations of genes that code for proteins in the myocardial contractile apparatus [91].

Arrhythmia predisposing genes have been identified and studied to provide further insight into the molecular pathobiology of arrhythmias [92]. Correspondingly, Gellens et al. [93] reported the SCN5A gene to encode subunits that form Na⁺ channels, which is responsible for triggering cardiac action potentials. SCN5A mutations give rise to a number of hereditary arrhythmias, including long-QT syndrome, idiopathic ventricular fibrillation, and cardiac-conduction disorders [94].

6. Strategies to tackle CVD among adolescents and youths in Nigeria (the health-promoting school approach)

Compared to developed nations, developing countries have seen an increase in CVD and associated risk factors, as well as a high death rate among young people. This can be due to the lack of information and practical preventive measures, which is also connected to the high levels of poverty in these nations [81]. Adequate knowledge of CVD risk factors is the first step toward an effective preventive mechanism against the burden of CVD among any population. Studies have identified children, adolescents, and young adults as the target population for the prevention program. Seven essential health conditions and habits, according to the American Heart Association, raise the risk of heart disease and stroke, such as dietary factors, smoking, being overweight or obese, being inactive, uncontrolled blood pressure, high cholesterol, and high blood sugar [95]. Ideal cardiovascular health is in line with the principle of primordial prevention, which refers to the prevention of risk factor development. Additionally, important is primary prevention, which is the management of risk factors in patients who have not yet manifested clinical CVD. The AHA considers persons with risk factors who have received optimal treatment to have intermediate cardiovascular health [96].

Primordial prevention looks to be the higher selection in addressing CVD, and this involves preventing risk factors from occurring by optimizing lifestyles related to smart management of vital signs, low levels of cholesterol, optimum body weight, physical activities and exercise, and elimination of tobacco use. Associate degree intervention of this type involves promoting positive health behaviors, effecting healthy lifestyle policies, and establishing a physical setting that ends up in incorporating and sustaining lifelong heart-healthy lifestyles, from infancy to old age. The American Heart Association guide for improving cardiovascular health at the community level provides a comprehensive list of goals, strategies, and recommendations that may be adopted and domesticated by both developed and developing countries to control cardiovascular diseases. The guide targets not solely health professionals but also government parastatals, nonprofit organizations, community-based organizations, institutions, public health practitioners, and the community [97].

The following strategies could be used to mitigate cardiovascular diseases among adolescents and youths in Nigeria.

6.1 Health promotion and education strategies

Action on the determinants of health is the prime focus of health promotion. It intends to promote efficient and involved public engagement. It integrates a number of different, yet complementary strategies. Included in this are community development, communication, education, legislation, organizational and community improvements, and unscheduled local health hazard prevention actions. Government, both at the provincial and federal levels, and different sectors, all have a part to play, by enhancing CVD prevention efforts through health promotion, environmental change, dietary treatments, and behavioral and lifestyle adjustments [98].

Health education is designed to enhance health literacy through communication to boost knowledge and develop life skills. Health education on the risk factors of CVDs and the ways to improve the health determinants ought to be advocated for. This includes information on the implications of tobacco use, alcohol, unhealthy diet, and lack of physical activities among others. This can be done through mass media campaigns, media adverts, radio chat show programs, bulk SMS, and alternative social networks including social media. This additional could be done by mobilizing communities through advocacy to community leaders and stakeholders and community sensitization meetings. Additionally, public campaigns and social-promoting initiatives to educate and encourage the target audience about healthy dietary habits should be conducted from the states down to the communities using appropriate and acceptable cultural methods. The benefits of physical activity should be taught, and various methods of undertaking them should be demonstrated [99].

6.2 Health-promoting schools

Schools at the primary, secondary, and tertiary levels should be mandated to have research-based, comprehensive, and age-appropriate curricula about cardiovascular health and ways in which to boost health behaviors and scale down CVD risk factors. The school curriculum should include lessons on the risk factors for CVD and stroke and also the extent of cardiopathy and stroke in the community. Research-based curriculum regarding effective ways of changing health behaviors can be implemented. Students should learn skills needed to achieve the regular practice of healthful behaviors, and parents should learn how to support their children’s healthful behaviors. All schools should be mandated to implement an age-appropriate curriculum on changing dietary, physical activity, and smoking behaviors [97].

6.3 Environmental modifications

Strategies to address occupational risks should be primary to the establishment of any workplace. The government should also enact and implement policies that promote smoke-free environments in all work sites, institutions, indoor public places, and other public places. More importantly, policy measures on the creation of health-promoting environments should be implemented before the licencing of any establishment, and means to effectively monitor the adoption of these policies should be put in place [100].

6.4 Nutritional interventions

The effective implementation of WHO recommendations on the marketing of foods and nonalcoholic beverages to children should be a top priority, including adequate mechanisms for monitoring. Effective guidelines should be developed with policy measures that engage different relevant sectors, such as food producers and processors and other relevant commercial operators to produce foods and drinks according to the appropriate terms. The government should effectively collaborate with the agricultural sector to supply policies and reforms for improvement within the provision of fruits and vegetables such that affordability is ensured. Promotion and provision of healthy food and food products should be encouraged by all public institutions including schools and workplaces [101].

6.5 Quality health care delivery

The National Academic Press (US), in 2010, recommends that along with select population-based approaches, a key step in addressing CVD is to strengthen health systems to deliver high-quality, responsive care for the prevention and management of CVD. This can be achieved by implementing provider-level strategies, health financing, and integration of care, workforce development, and access to essential medical products [102].

6.6 Policy change/reform

The primary population approach for the control of CVDs among adolescents and youths is largely dependent on the development and effective implementation of policies and regulations, especially those related to food, physical inactivity, and tobacco. These policy changes may include taxation and regulations on tobacco production and sales; regulations on tobacco and food marketing and labeling; and alterations in subsidies for foods and other food and agricultural policies. Implementation on a sufficient scale and adequate resources for evaluation is highly recommended [103].

7. Challenges to the development and implementation of these strategies

Major obstacles to the development and implementation of effective strategies to reduce the burden of cardiovascular disease among adolescents and youth in Nigeria is as a result of lack of knowledge, ineffective use of available and accessible resources, a dearth of sturdy population-level health and mortality data, insufficient financing for health and health care, suboptimal deployment of available health funding to support health services, and large population inequities [104]. According to Obansa and Orimisan, [105] inadequate laboratory facilities, a lack of basic infrastructure and equipment, poor human resource management, poor pay and motivation, a lack of fair and sustainable health care financing, and unequal and unjust economic and political relations between Nigeria and developed nations are just a few of the major factors that have an impact on the health system’s overall contribution to economic growth and development in Nigeria.

8. Conclusion

Since the prevalence of NCDs and their avoidable causes have been documented in Nigeria, the national health system requires targeted individual and population-wide prevention-oriented initiatives. Additionally, the health care system has to be improved in order to effectively handle all types of NCD prevention and control. This should serve as a wake-up call for all sectors, including the government, the general public, nongovernmental organizations, and funding agencies, to adopt an integrated and coordinated preventative strategy [106]. Individualized health education and skill development should be prioritized in order to help people choose and adopt a healthy lifestyle, which includes managing one’s nutrition, being active, and abstaining from tobacco and alcohol usage. People and communities should take the appropriate supporting steps to aid in the maintenance of individual choices with the ultimate goal of triggering a good communal impact. This is because individual behavior is influenced by common group practices and beliefs.

Additionally, stakeholder participation in promoting NCD prevention through community participation is also essential to the success of this drive, which may then be gradually integrated into the national health system. In light of the fact that well-designed community programs depend on successful basic and operations research, extensive public health interventions, and government policymaking, it is urgent to increase research funding and ensure that this research has a significant impact on policymaking. This is only achievable if the government is more devoted to providing strong leadership and coordinating the resources required for the prevention and treatment of NCDs [106].