Medical students in Nigeria must complete an intensive six-year program with few or no holidays or recreational periods. Therefore, it is not surprising that academic stress is commonly experienced by Nigerian medical students during the course of their training.

There is substantial evidence that academic stress adversely affects cardiovascular health.^1,2 We studied the cardiovascular health of our medical students and found that their high-density lipoprotein cholesterol (HDL-C) levels and total HDL-C/total cholesterol ratios changed unfavorably during final-year examinations,³ which suggested that our students are at risk of developing coronary artery disease. A significant reduction in the students' serum urea further suggests that they are not getting enough protein during final-year examinations.

We are also aware that during major sessional or professional examinations some students experience various types of illnesses, including psychological and behavioral disturbances. Because of these illnesses, some students take more than six years to complete their educations. It is therefore pertinent to look into the association between the nature of the biochemical alterations observed in the Nigerian students and the types of illnesses they usually present with during examinations. For instance, the students' low HDL-C and reduced urea levels during examinations tend to suggest that protein-rich lipids/lipoproteins may be more affected by academic stress. If this is true, then it would be correct to speculate that certain protein-rich lipids such as phospholipids (which are involved in maintaining the stability and integrity of cellular and brain barriers) may be altered during times of academic stress. One is therefore left to wonder whether the psychological and behavioral disturbances experienced by some students during examination times may be related to inadequate maintenance of the brain membrane lipids.

In order to improve the cardiovascular and mental health of students, as well as their academic performances, we are recommending that physical exercise and other recreational programs be incorporated into the medical curriculum in Nigerian medical schools. While our study focused solely on medical students in Nigeria, our findings certainly have implications for students in other parts of the world, who may experience similar changes in cardiovascular risk factors during times of academic stress.