Clonal chromosome aberrations in myeloid leukemia after styrene exposure

OBJECTIVES

The purpose of the study was to determine the risk of myeloid leukemia subclassified according to clonal chromosome aberrations in styrene-exposed workers.

METHODS

A nested case-referent study was carried out on 19 myeloid leukemia patients, of which 12 showed clonal chromosome aberrations, and 57 referents ascertained within the Danish reinforced plastics industry and similar industries with no styrene exposure.

RESULTS

A 2.5-fold increased risk for myeloid leukemia with clonal chromosome aberrations (95% confidence interval 0.2-25.0) was found among workers of companies with styrene exposure.

CONCLUSIONS

The results suggest that styrene may cause leukemia through a clastogenic effect. But similar findings could also have been found if the exposure was associated with a specific subtype of leukemia prone to develop the chromosome aberrations in question. Due to the few observations and the lack of detailed exposure data, additional studies are needed to corroborate or refute the present suggestive findings.

Insulin sensitivity in clinically healthy individuals with microalbuminuria

In epidemiologic studies microalbuminuria is associated with increased atherosclerotic risk profile, morbidity, and mortality. In order to examine whether such association could be explained by impaired insulin sensitivity, 23 clinically healthy subjects with microalbuminuria (urinary albumin excretion rate (UAER) of 6.6 to 150 micrograms/min) and 24 age- and sex-matched controls with normoalbuminuria (UAER < or = 6.6 micrograms/min) underwent a 3 h hyperinsulinaemic euglycaemic clamp investigation using an intravenous insulin infusion rate on 2 mU/(kg body weight x min). Insulin sensitivity (whole body glucose disposal) was similar in the two groups ((mean (95% C.I.)) 351 (321-381) vs. 364 (339-388) mg/(m2 x min); P = 0.51). Among urinary albumin excretion rate, blood pressure, serum lipid concentrations, body mass index waist-hip ratio, fasting concentrations of serum insulin and blood glucose, tobacco and alcohol consumption, physical activity, and age and sex, fasting serum insulin concentration was the only variable independently associated with insulin sensitivity (r = -0.55; P = 0.0001). It is concluded that microalbuminuria is not associated with impaired insulin sensitivity in clinically healthy individuals. The effect of microalbuminuria as predictor of atherosclerotic vascular disease may be mediated through other factors.

Treatment of renovascular hypertension: one year results of renal angioplasty

During the ten year period from 1981 to 1991, percutaneous transluminal renal angioplasty (PTRA) was performed in 180 renal arteries in 137 patients, where the underlying renovascular disease was fibromuscular dysplasia (FMD) in 30 patients (22%) and arteriosclerotic vascular disease (AVD) in 107 (78%). A preinterventional work-up and a re-evaluation of the patients after one year was designed for the assessment of the clinical, functional and technical outcome. Successful technical dilatation was achieved in 97% of procedures with FMD patients and in 82% of procedures with AVD patients. A beneficial effect on the blood pressure and the renal function was registered in both groups. The overall cure and improvement rate for hypertension was 86% in the FMD group and 64% in the AVD group after one year's follow-up. A significant gain in the total renal function was registered in both groups, the average increase in glomerular filtration rate being 13% (P < 0.001) for the FMD group and 11% (P < 0.001) for the AVD group one year after PTRA. Renal function was improved or unchanged in 89% of FMD patients and 74% of AVD patients. The improvement in renal function was made by the revascularized kidney. Renal vein renin investigation predicted the clinical outcome with an excellent diagnostic accuracy as no renin negative patient became normotensive, and renin positive patients, who did not turn normotensive, were in almost 90% of the cases affected by technical failure or restenosis/contralateral stenosis. Thus, the sensitivity of renal vein renin investigation was 95% and the specificity 75%. The outcome for patients with hypertension and renal insufficiency was considerably poorer than for the whole group of patients, with only a 20% success rate for hypertension, but 50% in this group had increased or unchanged GFR after intervention. The angiographic one-year follow-up revealed a recurrence rate of 6.7% for FMD and 15.1% for AVD. For the entire series of patients, the incidence of major complications was 5.4%, including one indirect fatality, while the incidence of minor complications was 5%. In conclusion, PTRA will cure or improve blood pressure in most patients with renovascular hypertension, and it preserves and even improves renal function in these patients. Complications and recurrence are in fact not very common and PTRA appears be the best first approach in all but ostial lesions for treatment of renovascular hypertension.

Gray hair, baldness, and wrinkles in relation to myocardial infarction: the Copenhagen City Heart Study

To investigate a possible relation between aging signs such as graying of the hair, baldness, and facial wrinkling and myocardial infarction (MI), we analyzed data from The Copenhagen City Heart Study. During the 12-year follow-up, 750 cases of first-time MI were observed. After statistical adjustment for possible confounders, we found a correlation between graying of the hair, facial wrinkling, and frontoparietal baldness and crown-top baldness and MI in men. For example, the relative risk was 1.4 (95% CI, 0.9 to 2.0) for men with moderately gray hair compared with men with no gray hair and 1.9 (1.2 to 2.8) for men with completely gray hair (p < 0.001). With regard to gray hair, a similar although weaker and not statistically significant trend was seen in women. We conclude that, in addition to established coronary risk factors, aging signs like graying of the hair, male baldness, and facial wrinkling indicate an additional risk of MI.

Reduced glomerular size- and charge-selectivity in clinically healthy individuals with microalbuminuria

The pathophysiologic mechanism behind microalbuminuria, a potential atherosclerotic risk factor, was explored by measuring fractional clearances of four endogenous plasma proteins of different size and electric charge (albumin, beta 2-microglobulin, immunoglobulin G, and immunoglobulin G4). Twenty-eight clinically healthy individuals with microalbuminuria, defined as a urinary albumin excretion of 6.6-150 micrograms min-1, and 60 matched control subjects were studied. Fractional immunoglobulin G clearance was higher (geometric means (95% confidence intervals)) 3.0 (2.3-3.9) x 10(-6), n = 28, vs. 2.1 (1.8-2.4) x 10(-6), n = 60; P = 0.02), whereas the ratio immunoglobulin G clearance/immunoglobulin G4 clearance was lower (geometric means (95% confidence intervals)) 1.8 (1.4-2.2), n = 28, vs. 2.3 (2.0-2.5), n = 60; P = 0.03) in microalbuminuric than in normoalbuminuric individuals. Fractional beta 2-microglobulin clearance was similar in the two groups. Since total IgG and the IgG4 subclass are of similar size and configuration but electrically neutral and negative, respectively; these findings indicate that microalbuminuria is associated with decreased size- and charge-selectivity of the glomerular vessel wall. Hypothetically, such alterations may reflect generalized vascular abnormalities linking microalbuminuria to atherogenesis.

Maternal smoking during childhood and increased risk of smoking in young adulthood

BACKGROUND

Effective prevention of smoking depends on the identification of factors that determine smoking onset. We examined the influence of family factors during childhood (household income, parents' education and smoking behaviour) on the subsequent risk of smoking in young adults.

METHODS

In 1979, 1300 children aged 6-18 years, whose parents were randomly selected for participation in the Copenhagen City Heart Study were invited to a health examination. Information about health and smoking behaviour was obtained from 73% of the children. A random sample of 579 of the children were invited to a follow-up examination 13 years later. In all, 486 (84%) participated in the follow-up.

RESULTS

The influence of household income, parents' smoking behaviour and education on the child's risk of becoming a smoker in young adulthood was estimated. Household income and parents' education did not significantly affect the risk of adult smoking. Maternal smoking during childhood increased the risk in comparison with the mother being a non-smoker (adjusted odds ratio = 1.95; 95% confidence interval: 1.07-3.58).

CONCLUSION

Maternal smoking during childhood increases children's risk of becoming young adult smokers, independent of age and smoking behaviour in childhood, gender and social background. In Denmark 28% of smoking in young adults could be attributed to maternal smoking.

Microalbuminuria reflects a generalized transvascular albumin leakiness in clinically healthy subjects

1. In epidemiological studies microalbuminuria, i.e. slightly elevated urinary albumin excretion rate, predicts increased atherosclerotic vascular morbidity and mortality. This study aimed to test the hypothesis that microalbuminuria in clinically healthy subjects is associated with a systemic transvascular albumin leakiness. In animal experiments the outflux of albumin and lipids to the arterial wall are highly correlated, and both are elevated in atherosclerosis. 2. All participants were recruited at random from a population-based epidemiological study, where the upper decile of urinary albumin excretion rate was 6.6 micrograms/min. Twenty-seven patients with persistent microalbuminuria (urinary albumin excretion rate 6.6-150 micrograms/min), and 56 age- and sex-matched control subjects with persistent normoalbuminuria (UAER < or = 6.6 micrograms/min) were studied. 3. The systemic transvascular albumin leakage was measured as the fractional disappearance rate of 125I-labelled albumin from the total plasma compartment in 1 h after intravenous injection. 4. The fractional disappearance rate of albumin from the plasma compartment was higher in the microalbuminuric than in the normoalbuminuric group [5.8 (95% confidence interval 5.3-6.2; n = 27) versus 5.0 (4.6-5.5; n = 56)%/h, P < 0.05]. The positive correlation between urinary albumin excretion rate on continuous scale (logarithmically transformed) and the fractional disappearance rate of albumin from the plasma compartment [slope 0.4 (95% confidence interval 0.1-0.7; n = 83), r = 0.29, P < 0.005] was independent of age, sex, smoking status, blood pressure, body size, plasma volume, plasma albumin concentration and concentrations of blood glucose, serum insulin and serum lipids. 5. In conclusion, microalbuminuria is an independent marker of systemic transvascular albumin leakiness in clinically healthy subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Mortality associated with moderate intakes of wine, beer, or spirits

OBJECTIVE

To examine the association between intake of different types of alcoholic drinks and mortality.

DESIGN

Prospective population study with baseline assessment of alcohol intake, smoking habit, income, education, and body mass index, and 10-12 years' follow up of mortality.

SETTING

Copenhagen city heart study, Denmark.

SUBJECTS

6051 men and 7234 women aged 30-70 years.

MAIN OUTCOME MEASURE

Number and time of cause-specific deaths from 1976 to 1988.

RESULTS

The risk of dying steadily decreased with an increasing intake of wine--from a relative risk of 1.00 for the subjects who never drank wine to 0.51 (95% confidence interval 0.32 to 0.81) for those who drank three to five glasses a day. Intake of neither beer nor spirits, however, was associated with reduced risk. For spirits intake the relative risk of dying increased from 1.00 for those who never drank to 1.34 (1.05 to 1.71) for those with an intake of three to five drinks a day. The effects of the three types of alcoholic drinks seemed to be independent of each other, and no significant interactions existed with sex, age, education, income, smoking, or body mass index. Wine drinking showed the same relation to risk of death from cardiovascular and cerebrovascular disease as to risk of death from all causes.

CONCLUSION

Low to moderate intake of wine is associated with lower mortality from cardiovascular and cerebrovascular disease and other causes. Similar intake of spirits implied an increased risk, while beer drinking did not affect mortality.

The effect of mobilization on cervical headaches

Headaches of cervical origin are often treated with mobilization. Mobilization of the upper cervical spine, occiput-C3, and effect on frequency, duration, and intensity of cervical headaches were studied utilizing an A-B-A single case design. Ten subjects who met the operational criteria of cervical headaches completed the study. A headache log was used to document headache frequency, duration, and intensity throughout all three phases (A-B-A). The baseline phase (A) lasted approximately 1 month, and no intervention was performed. The intervention phase (B) consisted of 9-12 treatment sessions, two times per week for 3-4 weeks. Visual analysis of data plots revealed a decrease in headache frequency, duration, and intensity from the baseline phase to the treatment phase. This improvement continued through the second A phase for frequency but leveled off for both duration and intensity. A one-way analysis of variance supported the findings from the visual analysis. In these 10 subjects, mobilization had a therapeutic effect on cervical headaches.

Aspects of haemostatic function in healthy subjects with microalbuminuria--a potential atherosclerotic risk factor

Microalbuminuria, i.e., slightly elevated urinary albumin excretion rate (UAER), notifies increased risk for atherosclerotic disease and may reflect an early generalized vascular abnormality in healthy subjects. This study was designed in order to examine whether such abnormality is associated with a shift of the haemostatic balance in prothrombotic direction. The following haemostatic factors were measured in two representative groups of clinically healthy subjects, 28 with microalbuminuria (UAER of 6.6-150 micrograms/min) and 60 age- and sex-matched controls with normoalbuminuria (UAER < 6.6 micrograms/min): Coagulation factors: blood platelet count and mean volume, plasma Factor VII antigen concentration and coagulant activity, and plasma concentrations of prothrombin fragment 1 + 2, thrombin-antithrombin III complexes, fibrinogen, and fibrinopeptide A; fibrinolytic and endothelial factors: plasma concentrations of tissue plasminogen activator antigen and plasminogen activator inhibitor type 1 antigen; and endothelial factor: plasma von Willebrand factor antigen concentration. The fibrinolytic and endothelial factors were measured both before and after 10 minutes of venous occlusion of the arm. None of the haemostatic factors were significantly altered in the microalbuminuric group. Plasma fibrinogen concentration tended to be elevated but not statistically significant ((mean (95% C.I.) 7.8 (7.2-8.3) vs. 7.2 (6.9-7.5) mumol/l; p < 0.1). Neither did any of the haemostatic factors correlate with UAER in regression analyses. It is concluded that the haemostatic balance is unaltered in healthy subjects with microalbuminuria. It is unlikely that a prothrombotic state is present as an intermedial factor early in a causal chain between microalbuminuria and atherosclerotic vascular disease.

Atherosclerotic risk factors are increased in clinically healthy subjects with microalbuminuria

Increased morbidity and mortality from atherosclerotic vascular disease were observed in subjects with slightly elevated urinary albumin excretion rate (UAER), known as microalbuminuria. Therefore, the association between microalbuminuria and established atherogenic risk factors was studied in clinically healthy subjects. All healthy 40-65 year-old participants with microalbuminuria, examined within the first 21 months of The Copenhagen City Heart Study, were invited, and 28 were studied. An age- and sex-matched group of 60 randomly chosen subjects with normoalbuminuria served as control. Microalbuminuria was defined as a UAER of 6.6-150 micrograms/min, and normoalbuminuria as a UAER < or = 6.6 micrograms/min. In the microalbuminuric group, systolic and diastolic blood pressures were both elevated (mean (95% C.I.) 128 (123-134) vs. 119 (116-122) mmHg; P = 0.005, and 75 (71-78) vs. 69 (67-71) mmHg; P = 0.008, respectively), and serum apolipoprotein (apo) A-1 concentration was lower (1.30 (1.20-1.37) vs. 1.42 (1.36-1.47) milligrams; P = 0.02) in comparison with the normoalbuminuric group. Furthermore, serum HDL-cholesterol concentration tended to be lower, whereas body weight, body mass index and fasting serum insulin concentration were slightly elevated in the microalbuminuric group but not statistically significant. It is concluded that microalbuminuria in clinically healthy subjects is associated with increased levels of atherogenic risk factors. This may contribute to the increased vascular morbidity and mortality observed in these individuals.

Improving long-term survival of patients with acute myocardial infarction from 1977-1988 in a region of Denmark

The aim of this investigation was to study secular trends in long-term survival following myocardial infarction (MI). Five thousand one hundred and fifty-seven consecutive cases of MI in 3942 patients were recorded in a well-defined region in the study period 1977-1988. The study period ended before thrombolytic therapy was introduced in the hospital. One and 5-year survival (+/- 95% confidence limits) was 61 +/- 2% and 42 +/- 2% in 1977-1980. These figures changed to 61 +/- 2% and 44 +/- 2% in 1981-1984, and to 64 +/- 2 and 46 +/- 2% in 1985-1988. The improvement with time was statistically significant (P < 0.001). In a Cox proportional hazard model, time of infarction was an independent predictor of survival. Patients were subdivided into a high risk group suffering from either congestive heart failure or cardiac arrest during hospitalization, and a low risk group without these complications. Year of infarction was without importance in the high risk group but highly significant in the low risk group. Long-term survival following MI gradually improved prior to the introduction of thrombolytic therapy. The improvement was confined to low risk patients without cardiac arrest or congestive heart failure.

[The association of alcohol and mortality. Significance of gender,age, weight and smoking]

The aim of the study was to examine the association between self-reported alcohol intake and subsequent mortality from all causes, and to examine if the effect of alcohol intake on the risk of death was modified by sex, age, body mass index, and smoking habits. In a prospective population study of 7,234 women and 6,051 men aged 30-79 years alcohol- and tobacco consumption and body mass index were assessed in the period 1976-1978, and the population was followed until 1.1.1988 for mortality. A U-shaped curve described the relation between alcohol intake and mortality. The nadir of the risk function was observed at one to six beverages per week (relative risk set at 1.00). Abstainers had a relative risk of 1.37 (95% confidence intervals: 1.20-1.56), whereas those drinking more than 70 beverages per week had a relative risk of 2.29 (1.75-3.00). Among the drinkers, the risk was significantly higher than 1 only among those drinking more than 42 beverages per week. Neither sex, age, body mass index, nor smoking significantly modified the risk function. Our findings suggest that simple messages about the benefits of total abstinence may not be appropriate.

Renovascular resistance in primary hypertension: experimental variations detected by means of Doppler ultrasound

OBJECTIVE

To gauge the influence of renovascular resistance changes on blood flow velocity pulsatility in kidneys of hypertensive patients by means of the ultrasonic colour and pulsed-wave Doppler method, since we have previously shown in normotensive subjects that the blood flow velocity pulsatility in renal interlobar arteries varies with changes in renovascular resistance.

METHODS

In six male patients with primary hypertension, renal blood flow velocity profiles were investigated by means of duplex ultrasound. Single-kidney renovascular resistance was assessed by measurements of split renal function (gamma-camera renography), renal plasma flow (steady-state para-aminohippurate clearance) and cuff blood pressure. The pulsatility index of the blood flow velocity spectrum in the renal interlobar artery and renovascular resistance were measured either at rest, during infusion of angiotensin II, or after angiotensin converting enzyme inhibition.

RESULTS

A significant correlation existed between pulsatility index and renovascular resistance (r = 0.50, P < 0.002), which did not improve after correction for the blood pressure pulsatility. Changes of pulsatility index were more closely related (r = 0.64, P < 0.001) to the corresponding changes in renovascular resistance.

CONCLUSIONS

With the two-dimensional image-guided colour and pulsed-wave Doppler method it is possible to assess semiquantitatively small intra-individual changes in renovascular resistance in hypertensive patients by means of pulsatility index measurements. Pharmacologically induced alterations in renovascular haemodynamics may therefore be evaluated with this technique.

Myocardial infarction 1979-1988 in Denmark: secular trends in age-related incidence, in-hospital mortality and complications

All admissions to a coronary care unit (CCU) in Copenhagen County were prospectively registered over a 10-year period, from 1979 to 1988, i.e. after the introduction of CCUs but before the era of intervention with thrombolytic or prophylactic medical treatment. The catchment area remained nearly constant throughout the study period; all patients with MI were admitted to the CCU regardless of age and concomitant diseases, and treatment and discharge policy of the department was unchanged. A total of 4176 MI admissions were registered. During the study period, the age-specific incidence of MI decreased in males above 50 years of age, but was virtually unchanged in females, increasing the proportion of women in the MI population from 26 to 33%. In-hospital and 30-day mortality was unchanged. The occurrence of atrial fibrillation during the admission increased significantly (from 11 to 18%), while the incidence of ventricular fibrillation, heart failure and pulmonary oedema was unchanged.

Microalbuminuria: an important diagnostic tool

The concept of microalbuminuria is reviewed. Measuring the urinary albumin excretion rate and testing for microalbuminuria is well established in the control and treatment of patients with insulin-dependent diabetes mellitus. Microalbuminuria predicts nephropathy and early cardiovascular death. In the presence of microalbuminuria frequent examinations are warranted for early detection of retinopathy, blood-pressure rise, and for optimizing the glycemic control. In patients with non-insulin-dependent diabetes, the independent value of microalbuminuria as a cardiovascular risk factor is not yet clarified. The urinary albumin excretion rate should be measured at diagnosis, because the indications are that presence of microalbuminuria reinforces the urge to intervene against other well-documented cardiovascular risk factors (hypertension, dyslipidemia, tobacco, and obesity). In the nondiabetic population, there is accumulating evidence that an elevated urinary albumin excretion rate is associated with early cardiovascular morbidity and mortality. Large scale cross-sectional and prospective studies are needed in order to clarify further the role of microalbuminuria as an independent risk factor in the background population.

Influence of sex, age, body mass index, and smoking on alcohol intake and mortality

OBJECTIVE

To examine the association between self reported alcohol intake and subsequent mortality from all causes and if the effect of alcohol intake on the risk of death is modified by sex, age, body mass index, and smoking.

DESIGN

Prospective population study with baseline assessment of alcohol and tobacco consumption and body mass index, and 10-12 years' follow up of mortality.

SETTING

Copenhagen city heart study, Denmark.

SUBJECTS

7234 women and 6051 men aged 30-79 years.

MAIN OUTCOME MEASURE

Number and time of deaths from 1976 to 1988.

RESULTS

A total of 2229 people died, 1398 being men. A U shaped curve described the relation between alcohol intake and mortality. The lowest risk was observed at one to six alcoholic beverages a week (relative risk set at 1). Abstainers had a relative risk of 1.37 (95% confidence interval 1.20 to 1.56) whereas those drinking more than 70 beverages a week had a relative risk of 2.29 (1.75 to 3.00). Among the drinkers, the risk was significantly increased only among those drinking more than 42 beverages a week. Sex, age, body mass index, and smoking did not significantly modify the risk function. The risk among heavy drinkers was slightly reduced when smoking was controlled for. The risk function was similar in the first and second period of six years of observation.

CONCLUSION

Alcohol intake showed a U shaped relation to mortality with the nadir at one to six beverages a week. The risk function was not modified by sex, age, body mass index, or smoking and remained stable over 12 years.

The health insurance picture in 1993: some rare good news

Based on a national survey conducted in spring 1993 of 1,953 private and public employers, this DataWatch examines the design of employer-sponsored health benefits and how they have changed during the past five years. We contrast cost of coverage, employee cost sharing, and premium increases among small, mid-size, and large firms. Premiums increased 8.5 percent from 1992 to 1993, the lowest rate of increase since 1986-1987. Future premium increases should be modest by historical standards. Small firms and conventional plans experienced larger premium increases last year. Managed care plans now constitute 51 percent of enrollment, up from 29 percent in 1988. If current trends continue, even without health care reform legislation, the health care system of the future will contrast strikingly with the system most Americans remember from past decades.

[Microalbuminuria--a valuable diagnostic parameter]

The concept of microalbuminuria is reviewed. Measuring the urinary albumin excretion rate and testing for microalbuminuria is well established in the control and treatment of patients with insulin-dependent diabetes mellitus. Microalbuminuria predicts nephropathy and early cardiovascular death. In the presence of microalbuminuria, frequent examinations are warranted for early detection of retinopathy, hypertension and for optimizing the glycaemic control. In patients with non-insulin dependent diabetes, the independent value of microalbuminuria as a cardiovascular risk factor is not yet clarified. The urinary albumin excretion rate should be measured at diagnosis, because the indications are that presence of microalbuminuria reinforces the urge to intervene against other well-documented cardiovascular risk-factors (hypertension, dyslipidemia, tobacco and obesity). In the non-diabetic population there is accumulating evidence that an elevated urinary albumin excretion rate is associated with early cardiovascular morbidity and mortality. Large scale cross-sectional and prospective studies are needed in order to further clarify the role of microalbuminuria as an independent risk factor in the background population.

[Screening of microalbuminuria with the Micral-Test. A semi-quantitative urinary dipstick]

Microalbuminuria, defined as a urinary albumin excretion rate of 20-200 micrograms/min, predicts diabetic nephropathy and cardiovascular disease in diabetic patients. An increased urinary albumin excretion rate is probably also associated with cardiovascular disease in non-diabetic subjects. Thus, screening for microalbuminuria is of major importance. A semi-quantitative urinary dipstick method, Micral-Test, has been developed for this purpose. In a urine sample collected overnight from each of 1359 subjects the Micral-Test was evaluated with a quantitative ELISA-method as the standard. Sensitivity, specificity and diagnostic specificity in detecting microalbuminuria was 92, 58 and 12% respectively. The prevalence of microalbuminuria was 5.6%. In conclusion, the Micral-Test is highly sensitive in detecting microalbuminuria, but at the expense of a relatively high number of false positive tests.

Urinary albumin excretion in a population based sample of 1011 middle aged non-diabetic subjects. The Copenhagen City Heart Study Group

Increased urinary albumin excretion rate (UAER) especially in the range of 20-200 micrograms min-1, termed microalbuminuria, has been proposed as a risk marker and predictor for cardiovascular disease in non-diabetic subjects. Thus it would be of importance to describe the distribution of UAER in the non-diabetic population. Among 1011 30-70-year-old subjects without diabetes mellitus or urinary tract infection, who were invited to participate in a population based epidemiological study, the albumin concentration was measured in an overnight urine sample. The measurement was performed by an ELISA method. The UAER was calculated in units of micrograms min-1 as urinary albumin concentration x urine volume/urine collection time. The distribution of UAER was positively skewed with a median value of 2.3 micrograms min-1 and a 5-95 interpercentile range of 0-11.0 micrograms min-1. The UAER held constant with age, but males had higher UAER than females, 2.6 (0-13.5) micrograms min-1 vs 2.2 (0-8.3) micrograms min-1; p < 0.005. The prevalence of microalbuminuria, defined as an UAER in the range of 15-150 micrograms min-1 in an overnight urine sample, was 3% (95% C.I. interval: 1.9-4.0). These findings suggest, that the level of UAER which might notify increased cardiovascular risk, is lower than in patients with diabetes mellitus, if it is considered to be of any clinical relevance.

[No increase in the prevalence of vertebral fractures among postmenopausal women over a 10-year period]

We examined whether the prevalence of vertebral fracture in otherwise healthy, 70-year-old Danish women had increased over a period of ten years. The population-based, epidemiological study included two age-matched, representative samples of postmenopausal women. Group 1 (1979) consisted of 173 healthy women without secondary causes of osteoporosis, Group 2 (1989) of 387 women. X-rays of the thoraco-lumbar spine were assessed for vertebral fracture by five radiological methods. There was no significant difference between the two groups in the prevalence of vertebral fracture and the 95% confidence intervals overlapped completely in all methods. The prevalence rates varied by method from 35% to 80% but the distribution of fracture types was similar in the two groups. We conclude that the prevalence of vertebral fractures due to postmenopausal osteoporosis has not increased since 1979 in suburban Copenhagen, and that comparison of prevalences requires the same method of radiological assessment.

[Tobacco, lung cancer and chronic obstructive lung disease. Results from the Osterbro study]

Data from The Copenhagen City Heart Study, a prospective population study, were analysed to investigate the influence of the type of tobacco and inhalation on mortality from lung cancer and chronic obstructive pulmonary disease (COPD). The study sample comprised 2986 plain cigarette smokers, 3222 filter cigarette smokers, 1578 smokers of cheroots/cigars, 433 male pipe smokers and 773 smokers smoking more than one type of tobacco. From 1976 to the end of 1989 we observed 268 deaths from lung cancer and 195 deaths, where COPD was considered as either the main or the contributory cause of death. Current smokers of all types of tobacco had a significantly higher risk of mortality from the investigated diseases than never-smokers. In both sexes the risks of death from both lung cancer and COPD were lower in cheroot/cigar smokers and in pipe smokers than in cigarette smokers, but these differences were markedly diminished after an adjustment for the inhalation habit. The present study substantiates that tobacco smoking increases pulmonary mortality. The small differences between the various types of tobacco are probably caused by different inhalation patterns.