CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018 106 AFRICA Prevalence of cardiometabolic risk factors among professional male long-distance bus drivers in Lagos, south-west Nigeria: a cross-sectional study Casmir E Amadi, Tim P Grove, Amam C Mbakwem, Obianuju B Ozoh, Oyewole A Kushimo, David A Wood, Michael Akinkunmi Abstract Background: Professional drivers are known to be at high risk of cardiovascular disease (CVD). This study was carried out to highlight these risk factors and their predictors among male long-distance professional bus drivers in Lagos, south- west Nigeria, with a view to improving health awareness in this group. Methods: Socio-demographic data, anthropometric indices, blood pressure, fasting plasma blood glucose levels and lipid and physical activity profiles of 293 drivers were measured. Results: Mean age of the study population was 48 ± 9.7 years; 71.0 and 19.5% of the drivers used alcohol and were smokers, respectively; and 50.9% were physically inactive. The preva- lence of overweight and obesity was 41.7 and 21.1%, respec- tively, while 39.7 and 13.9% were hypertensive and diabetic, respectively. Ninety (31.3%) subjects had impaired fasting glucose levels while 56.3% had dyslipidaemia. Predictors of hypertension were age and body mass index (BMI). BMI only was a predictor of abnormal glucose profile. Conclusion: Professional male long-distance bus drivers in this study showed a high prevalence of a cluster of risk factors for CVD. Keywords: cardiovascular disease, risk factors, long-distance drivers Submitted 26/5/17, accepted 14/1/18 Published online 19/2/18 Cardiovasc J Afr 2018; 29: 106–114 www.cvja.co.za DOI: 10.5830/CVJA-2018-006 Atherosclerotic cardiovascular disease (CVD), typified by coronary heart disease (CHD) and stroke, is a pre-eminent cause of preventable and premature mortality globally, accounting for about 30% of global deaths. 1 This is expected to increase by almost 50% by 2030. 2 It is also a major cause of mass disability and a somatic cause of loss of productivity globally, with over 150 million disability adjusted life years (DALYS). 3 About 80% of this burden from CVD is borne by low- and middle-income countries (LMIC). 1 Globally, CVD prevalence is on the increase, remarkably so in the LMIC. This is largely due to increased urbanisation and its corollary of better socio-economic opportunities and Westernisation of lifestyles, such as sedentary living, unhealthy dietary choices, tobacco use, psycho-social stress and harmful use of alcohol. 4 These behavioural risk factors predispose to intermediary or metabolic risk factors, such as hypertension, abnormalities in blood glucose levels, dyslipidaemia, overweight and obesity. 5,6 One of the socio-economic consequences of urbanisation is mass transit of people, goods and services across regions and long distances via land, air and waterways. The consequence of this is the creation of effective road transport systems in urban areas, with an increase in the number of people engaged in professional driving. Professional drivers as an occupational group are at increased risk of CVD. Morris et al., in their seminal research in 1953, documented that London bus drivers were at increased risk for CHD compared to the more active bus conductors. 7 Several other occupational epidemiological studies have provided evidence that professional drivers (short- and long-distance drivers) suffer more and die from CVD. 8-11 This excess of CVD morbidity and mortality risk among this group is attributable to a high prevalence of CVD risk factors, such as obesity, hypertension, sedentary living, diabetes, smoking and unhealthy diets found in them. 12-14 Beyond these conventional risk factors for CVD, various driving-related activities, such as traffic congestion, ergonomic factors, long-distance driving, shift work, and anxiety and tension from the job of driving have also been implicated. These are known to cause various neuroendocrine and neurocardiological responses, such as increased secretion of cortisol and catecholamines, and decreased heart rate variability, which may also be possible mediators of CVD. 15,16 They can also be considered a vulnerable group with social gradients of inequalities; they usually belong to the lower socio-economic class, are not well educated/informed and are not usually covered by public health policies. They also work under immense anxiety and stress. These further heighten their risk for CVD. Lagos is the second most populous city in Nigeria, the second fastest growing city in Africa and the seventh in the world. 17 It is Department of Medicine, College of Medicine, University of Lagos, Nigeria Casmir E Amadi, MD, acetalx@yahoo.com Amam C Mbakwem, MD Obianuju B Ozoh, MD National Heart and Lung Institute, Imperial College, London Tim P Grove, MSc David A Wood, PhD Department of Medicine, Lagos University Teaching Hospital, Nigeria Oyewole A Kushimo, MD Michael Akinkunmi, MD