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Vital exhaustion, a psychological measure characterized by fatigue and depressive symptoms, has been suggested to be an independent risk factor for ischaemic heart disease (IHD) but the generality of the phenomenon remains in question. The aim of this study is to describe prevalence of these symptoms in a community sample and determine whether they prospectively predict increased risk of IHD and all-cause mortality in men and women.

Reduced lung function has been shown to be a significant predictor of non-fatal ischaemic heart disease, and of mortality due to cardiovascular disease. Fewer studies have analysed the relationship between lung function and risk of fatal or non-fatal stroke. The present study presents results on the relation between forced expiratory volume in one second (FEV1) and risk of incident and fatal first-ever stroke.

Background Reduced lung function has been shown to be a significant predictor of non-fatal ischaemic heart disease, and of mortality due to cardiovascular disease. Fewer studies have analysed the relationship between lung function and risk of fatal or non-fatal stroke. The present study presents results on the relation between forced expiratory volume in one second (FEV1) and risk of incident and fatal first-ever stroke.Subjects and Methods The analyses are based on prospective cohort data from 12 878 eligible men and women aged 45–84 years, who participated in the first health examination of the Copenhagen City Heart Study in 1976–1978. The subjects were followed from day of entry until 31 December 1993. During that period 808 first-ever strokes occurred of which 153 were fatal within 28 days. Risk of incident and fatal stroke was estimated by means of Cox hazard regression. The analyses included adjustment for potential confounders: sex, age, smoking, inhalation, body mass index, systolic blood pressure, triglycerides, physical activity in leisure time, education, diabetes mellitus, and antihypertensive treatment.Results We found an inverse association between FEV1 and risk of first-time stroke. For each 10% decrease in FEV1 in percentage of expected, the relative risk (RR) increased 1.05 (95% CI : 1.00–1.09, P =0.03). This represents an approximately 30% higher risk of stroke in the group of people with the lowest lung function as compared to the group with the highest lung function. The association between lung function and risk of fatal stroke resembled that of risk of incident stroke (fatal and non-fatal). The RR was 1.11 (95% CI : 1.03–1.19) for each 10% decrease in FEV1 in percentage of expected. This represents approximately a doubling of the risk between the highest and lowest lung function groups.Conclusions This study shows that reduced lung function measured in percentage of predicted FEV1 is a predictor of first-time stroke and fatal stroke independent of smoking and inhalation. The high risk of fatal first-ever stroke in the group of people with low lung function may be of significance in both the design and interpretation of clinical trials.

Lange P (Medical Department B 2011, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen �, Denmark) Groth S, Nyboe J, Mortensen J, Appleyard M, Schnohr P and Jensen G. Determinants of Chronic mucus hypersecretion in a general population with special reference to the type of tobacco smoked. International Journal of Epidemiology 1989, 18: 882–887. Data from a prospective study of 3884 smokers and 3676 non-smokers followed for five years were analysed to investigate the determinants of chronic mucus hypersecretion (CMH). During the follow-up 414 (10.7%)smokers and 140 (3.8%) non-smokers developed CMH. The influence of the type of tobacco smoked (plain cigarettes, filter cigarettes, pipe and cheroots/cigars), lifetime tobacco consumption, age, alcohol consumption, and socioeconomic status on the development of CMH was assessed in men and women separately using multiple logistic regression. In smokers of both sexes, the risk of developing CMH increased significantly with lifetime tobacco consumption and almost significantly with age. In male smokers, the risk of developing CMH increased with alcohol consumption but was not significantly related to the type of tobacco smoked. In female smokers, the risk of CMH increased significantly with short school education and was, after adjustment for the amount of tobacco smoked, approximately twice as high in cigarette smokers as in cheroot smokers. However, as female cheroot smokers on the average consumed much more tobacco than female cigarette smokers the incidence of CMH was almost the same in the two groups. Among current non-smokers, the risk of developing CMH increased with age and previous tobacco consumption. It is concluded that although a number of factors are associated with the development of CMH, tobacco smoking, regardless of the type of tobacco, is a major determinant of CMH.