No abstract

Suboptimal glycemic control is common in medical inpatients with diabetes mellitus. The risk of suboptimal control is associated with selected demographic and clinical characteristics, which can be ascertained at hospital admission. Although sliding scale insulin regimens are prescribed for the majority of inpatients with diabetes, they appear to provide no benefit; in fact, when used without a standing dose of intermediate-acting insulin, they are associated with an increased rate of hyperglycemic episodes.

Obesity, excessive weight gain in young adulthood, and hypertension are risk factors for the development of gout. Prevention of obesity and hypertension may decrease the incidence of and morbidity from gout; studies of weight reduction in the primary and secondary prevention of gout are indicated.

Stroke mortality has been falling rapidly in this country since 1973. To investigate age-race-sex effects on stroke mortality, we studied US vital statistics during 1950-1972 and 1973-1981 in 55-64-, 65-74-, and 75-84-year-old race-sex groups. The accelerated rate of decline in stroke mortality since 1973 has had a substantial public health impact, with >200,000 fewer stroke deaths than would otherwise have occurred. For all groups, stroke mortality declined at a greater rate (/?<0.05) in 1973-1981 than during 1950-1972. The rates of decline during 1973-1981 were greater with increasing age (/?<0.05) and were more substantial for younger blacks. There were no consistent differences in the rate of decline by sex. The greater rate of decline hi absolute stroke mortality in the older age groups and blacks was explained by higher baseline mortality in these groups. Overall This recent downturn in mortality has been seen in most Western nations 3 and has been attributed to improved treatment and control of hypertension. 24 -7 Despite these favorable trends, stroke remains the third leading cause of death and stroke-associated morbidity and mortality are important public health problems. 8 The notion that the accelerated decline in stroke mortality has resulted from increased use of antihypertensive drug therapy in the general community is certainly plausible. However, little evidence has been generated to document the validity of this putative association. Received May 11, 1988; accepted August 3, 1988. In three US national surveys performed during the period of accelerated decline in stroke mortality, consistent techniques have been used to gather information regarding the prevalence of treatment and control of hypertension in the general community. 9 With this in mind, we decided to explore the public health implications of the recent accelerated decline in US stroke mortality and to identify the relation between the decline and national trends in the prevalence of treatment and control of hypertension. Specifically, we set out to 1) estimate the reduction in deaths attributable to the accelerated decline, 2) determine how the accelerated decline varied by age, race, and sex, and 3) determine if the prevalence of hypertension therapy among various age-race-sex groups was associated with the decline in the rate of stroke mortality. Subjects and MethodsRace-and sex-specific stroke mortality for 1950-1981 was obtained for the 55-64-, 65-74-, and 75-84-year-old age groups from US vital statistics data.10 Because mortality for blacks was not available for the entire study period, death rates for nonwhites were used. To provide a period during which the prevalence of antihypertensive drug therapy varied considerably, we studied temporal trends in stroke mortality between 1950 and 1981. Thiazide diuretics were introduced in 1958, but antihypertenby guest on May 11, 2018 http://stroke.ahajournals.org/ Downloaded from

Low HDL-C (or high TC:HDL-C) is strongly predictive of subsequent cardiovascular events in subjects with CAD, despite desirable TC. As such, identification of this potentially modifiable risk factor should be actively pursued in this high-risk subgroup.