The treatment of stroke remains ineffective, and prevention is the key issue for this common disease. Norris and Hachinski have recruited an international group of experts to provide a comprehensive, critical review of the evidence on the primary and secondary prevention of cerebrovascular disease and to translate this information into clinical practice. The authors present fresh information on established risk factors such as atrial fibrillation, smoking and hypertension and on new risk factors such as homocysteinemia and the paradoxical role of alcohol. They cover the protective effects of lifestyle changes, diet, exercise, and estrogen. Under secondary prevention, they deal with aspirin, antiplatelet therapy, surgical measures to prevent stroke, angioplasty and stenting, and the importance of cardiac anomalies increasingly revealed by high-definition imaging. While endarterectomy remains controversial for asymptomatic carotid stenosis, it has been clearly defined as the single most effective strategy in secondary prevention. In a concluding section that will be particularly valuable to clinical readers, the authors provide a lucid, balanced discussion of how the findings from clinical trials, where patients are highly selected, closely monitored, and given the highest standard of care, can be effectively applied in the everyday practice of medicine.