**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].
