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In persons with type 2 DM, the risk of having an incident myocardial infarction or stroke is increased 2- to 3-fold and the risk of death is increased 2-fold, independent of other known risk factors for cardiovascular diseases.

Background-The aim of this study was to assess the level of urinary albumin excretion (microalbuminuria), which is associated with increased risk of coronary heart disease and death, in the population. Microalbuminuria has been suggested as an atherosclerotic risk factor. However, the lower cutoff level of urinary albumin excretion is unknown. It is also unknown whether impaired renal function confounds the association. Methods and Results-In the Third Copenhagen City Heart Study in 1992 to 1994, 2762 men and women 30 to 70 years of age underwent a detailed cardiovascular investigation program, including a timed overnight urine sample. The participants were then followed up prospectively by registers until 1999 with respect to coronary heart disease and until 2001 with respect to death. During follow-up, 109 incident cases of coronary heart disease and 276 deaths were traced. A urinary albumin excretion above the upper quartile, ie, 4.8 g/min, was associated with increased risk of coronary heart disease (RR, 2.0; 95% CI, 1.4 to 3.0; PϽ0.001) and death (RR, 1.9; 95% CI, 1.5 to 2.4; PϽ0.001) independently of age, sex, renal creatinine clearance, diabetes mellitus, hypertension, and plasma lipids. Lower levels of urinary albumin excretion were not associated with increased risk. Conclusions-Microalbuminuria, defined as urinary albumin excretion Ͼ4.8 g/min (corresponding to Ϸ6.4 g/min during daytime), is a strong and independent determinant of coronary heart disease and death. Our suggestion is to redefine microalbuminuria accordingly and perform intervention studies.

Chronic obstructive pulmonary disease has been associated with a high frequency of arrhythmias. Few studies have analysed the role of reduced lung function in predicting atrial fibrillation (AF). The aim of the present study was to investigate the relationship between forced expiratory volume in one second (FEV1) and risk of first episode of AF in a prospective study.Data from 13,430 males and females without previous myocardial infarction, who participated in the Copenhagen City Heart Study, were analysed. New AF was assessed at re-examination after 5 yrs and by hospital admission for AF during a period of 13 yrs. Multivariate analyses were used with adjustment for cardiopulmonary risk factors. There were 62 new cases of AF at 5-yr follow-up (0.58%) and 290 cases (2.20%) diagnosed at hospitalisations.Risk of new AF at re-examination was 1.8-times higher for FEV1 between 60-80% of predicted compared with FEV1 o80% after adjustment for sex, age, smoking, blood pressure, diabetes and body mass index. The risk of AF hospitalisation was 1.3-times higher for FEV1 between 60-80% and 1.8-times higher for FEV1 v60% compared with FEV1 o80%, when additional adjustment was made for education, treatment with diuretics and chest pain at activity.The authors conclude that reduced lung function is an independent predictor for incident atrial fibrillation. The Copenhagen City Heart Study was funded by the Danish Heart Foundation. P. Buch was the recipient of a Danish Heart Foundation introduction grant (01-1-9-F3-22880).Chronic obstructive pulmonary disease (COPD) has been associated with a high frequency of cardiac arrhythmias. Hypoxaemia [1, 2], acidosis [3], cor pulmonale and coexisting ischaemic heart disease (IHD) [4,5] have been proposed as major causes for the relationship between COPD and arrhythmias. The risk of arrhythmias in patients with COPD is influenced by the state of the disease, with a higher frequency of supraventricular tachycardia during exacerbations [1, 2, 5]. However, even in patients with stable COPD the incidence of cardiac arrhythmias is considerable [6], and, in clinical practice, it is not uncommon to find atrial fibrillation (AF) in patients hospitalised for COPD. AF is by far the most common arrhythmia in the elderly population but only a few studies have analysed the relationship between lung function and the risk of developing AF in detail. It is important to investigate the correlation between reduced lung function and AF since the incidence of COPD is expected to increase considerably in the future, reflecting prior smoking habits of an ageing population [7,8]. The aim of the present study, therefore, was to investigate the role of reduced lung function in development of AF based on a representative sample of the general population free of IHD at baseline. Methods Study populationThis study was based on data from the Copenhagen City Heart Study (CCHS). The original cohort of CCHS comprised a random age-stratified sample of 19,329 males and females aged o20 yrs from an area of Copenha...

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