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Summary Background COPD can be diagnosed early using spirometry, but spirometry use is only recommended in symptomatic smokers, even though early stages of COPD can be asymptomatic. We investigated the prognosis of individuals with asymptomatic and symptomatic, undiagnosed COPD in the general population in Denmark. Methods In this prospective cohort study, we analysed data from 95 288 individuals aged 20–100 years from the Copenhagen General Population Study. 32 518 (34%) of these individuals were regarded as being at high risk for COPD (defined as individuals aged 40 years or older, with cumulative tobacco consumption of ten pack-years or higher, and without self-reported or a previous hospital contact for asthma). COPD was defined as FEV 1 /forced vital capacity (FVC) of less than 70% and less than the lower limit of normal, and FEV 1 of less than 80% of the predicted normal value. Individuals were considered undiagnosed if neither a previous COPD hospital contact, nor medical treatment for COPD, was registered. We obtained information on exacerbations and pneumonia from the National Danish Patient Registry and vital status from the National Danish Civil Registration System, and cause of death from the National Danish Causes of Death Registry. We used Cox proportional hazard models to assess risk of exacerbations, pneumonia, deaths due to respiratory causes, and deaths from all causes from 2003 to 2014. Findings Between Nov 26, 2003, and July 10, 2013, 95 288 individuals were screened and 32 518 (34%) were at high risk of having COPD. 3699 (11%) of these participants met the COPD criteria and 2903 (78%) were undiagnosed, of whom 2052 (71%) were symptomatic. During a median follow-up of 6·1 years (IQR 4·9), we recorded 800 exacerbations, 2038 cases of pneumonia, and 2789 deaths in the 32 518 individuals at high risk of having COPD, including 152 deaths due to respiratory disease. Compared with individuals without COPD, the age and sex adjusted hazard ratio (HR) was 5·0 (95% CI 2·8–8·9) for exacerbations, 1·7 (1·3–2·2) for pneumonia, 0·7 (0·2–3·0) for death from respiratory causes, and 1·3 (1·1–1·6) for death from all causes in individuals with undiagnosed, asymptomatic COPD. Corresponding HRs were 15·5 (11·0–21·8) for exacerbations, 2·8 (2·4–3·3) for pneumonia, 4·3 (2·8–6·7) for death from respiratory causes, and 2·0 (1·8–2·3) for death from all causes in individuals with undiagnosed, symptomatic COPD. Interpretation Individuals with undiagnosed, symptomatic COPD had an increased risk of exacerbations, pneumonia, and death. Individuals with undiagnosed, asymptomatic COPD had an increased risk of exacerbations and pneumonia. These findings suggest that better initiatives for early diagnosis and treatment of COPD are needed. Funding The Danish Lung Association, the Danish Cancer Society, Herlev and Gentofte Hospital, Copenhagen University Hospital, and University of Copenhagen. [ABSTRACT FROM AUTHOR]

After the introduction of statins, clinical emphasis first focussed on LDL cholesterol-lowering, then on the potential for raising HDL cholesterol, with less focus on lowering triglycerides. However, the understanding from genetic studies and negative results from randomised trials that low HDL cholesterol might not cause cardiovascular disease as originally thought has now generated renewed interest in raised concentrations of triglycerides. This renewed interest has also been driven by epidemiological and genetic evidence supporting raised triglycerides, remnant cholesterol, or triglyceride-rich lipoproteins as an additional cause of cardiovascular disease and all-cause mortality. Triglycerides can be measured in the non-fasting or fasting states, with concentrations of 2-10 mmol/L conferring increased risk of cardiovascular disease, and concentrations greater than 10 mmol/L conferring increased risk of acute pancreatitis and possibly cardiovascular disease. Although randomised trials showing cardiovascular benefit of triglyceride reduction are scarce, new triglyceride-lowering drugs are being developed, and large-scale trials have been initiated that will hopefully provide conclusive evidence as to whether lowering triglycerides reduces the risk of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Summary: Background: A substantial proportion of patients with chronic obstructive pulmonary disease (COPD) have never smoked. We tested the hypothesis that, in individuals with COPD, never smokers have different characteristics and less severe outcomes of the disease than smokers do. Methods: We included individuals from the Copenhagen General Population Study, a prospective population study. We identified individuals with COPD spirometrically; that is, as the ratio between forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) under the lower limit of normal (LLN), excluding individuals with self-reported asthma. We examined general characteristics, symptoms, disease severity, and levels of inflammatory biomarkers and α1-antitrypsin at baseline. We assessed risk of lung-related hospital admissions, cardiovascular comorbidities, and all-cause mortality during a median follow-up of 4 years (IQR 2·5–5·6). Findings: Between Nov 26, 2003, and July 29, 2010, 68 501 participants from the Copenhagen General Population Study had lung function measurements and complete information on smoking habits available. Of those, we identified 6623 with COPD and no asthma. Of these, 1476 (22%) were never smokers, 2696 (41%) former smokers, and 2451 (37%) current smokers. For comparison we included 24 529 never smokers without COPD. Never smokers with COPD had different clinical characteristics, fewer symptoms, milder disease, and lower levels of inflammatory biomarkers than did current and former smokers with COPD. During follow-up, HRs for hospital admission due to COPD were 8·6 (95% CI 5·3–14) in never smokers, 30 (22–41) in former smokers, and 43 (32–59) in current smokers compared with never smokers without COPD. HRs for hospital admission due to pneumonia were 1·9 (1·4–2·6) in never smokers, 2·8 (2·3–3·4) in former smokers, and 3·4 (2·9–4·2) in current smokers. For hospital admission due to lung cancer, HRs were 11 (5·7–23) in former smokers and 18 (9·2–35) in current smokers, whereas no cases were noted in never smokers. Furthermore, risk of cardiovascular comorbidities and all-cause mortality was increased in former and current smokers but not in never smokers with COPD. Interpretation: Compared with current and former smokers, never smokers with COPD had different characteristics and milder disease, limited to the lungs. However, morbidity due to lung-related hospital admissions was nonetheless substantial in never smokers with COPD. Funding: Herlev Hospital, Copenhagen University Hospital, Copenhagen County Foundation, and University of Copenhagen. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated the association between high density lipoprotein (HDL)-cholesterol and the occurrence of cardiovascular events after treatment with potent statin therapy. The study involved adults who were not suffering from diabetes or previous cardiovascular disease. The authors of the study found that rosuvastatin 20 milligrams (mg) per day reduced the incidence of the primary endpoint by 44 percent. It was concluded that HDL-cholesterol concentrations were not predictive of residual vascular risk.