Developing an Original Biochemical Risk Index for Predicting Cardiovascular Events in Nigerian Adults: A Multi-Centre Prospective Study

Existing cardiovascular risk prediction algorithms including the Framingham and SCORE models were developed in predominantly European populations and may not accurately predict cardiovascular event risk in Nigerian adults, whose risk factor profiles, dietary patterns, and genetic backgrounds differ substantially. This dissertation develops an original biochemical risk index for cardiovascular event prediction in Nigerian adults through a multi-centre prospective cohort study. Ten thousand apparently healthy adults aged thirty to seventy years were recruited across twelve tertiary and secondary health facilities in Lagos, Abuja, Ibadan, Kano, Enugu, and Port Harcourt. At enrolment, a comprehensive biochemical risk factor panel was measured including standard and advanced lipid parameters (LDL-C, HDL-C, triglycerides, apolipoprotein B, lipoprotein(a), small dense LDL particle number), inflammatory biomarkers (CRP, fibrinogen, IL-6), metabolic biomarkers (fasting glucose, HbA1c, insulin, HOMA-IR), kidney function markers, homocysteine, and uric acid. Anthropometric, blood pressure, lifestyle, and family history data were concurrently collected. Participants were followed prospectively for five years with annual biochemical reassessment and event capture for myocardial infarction, stroke, cardiac death, and revascularization procedures. Cox proportional hazards regression and machine learning ensemble approaches identified the biochemical and clinical variables with the strongest prospective cardiovascular event prediction in this Nigerian cohort. The Nigerian Cardiovascular Biochemical Risk Index constructed from these analyses outperformed the Framingham model calibration in this population and identified apolipoprotein B, lipoprotein(a), uric acid, and HOMA-IR as stronger Nigerian-specific predictors than some Framingham variables. An online calculator was developed for clinical use. Keywords: cardiovascular risk prediction, biochemical risk index, Nigeria, prospective cohort, multi-centre study.