Despite major advances in the understanding of stroke mechanisms that have occurred over the
past quarter century stroke continues to rank among the leading causes of death and disability
worldwide. Although currently it may be difficult to believe early doubts were expressed as to
whether inter ventions in risk factors for either coronary disease or stroke would actually
lead to a reduction in the incidence of these disorders. However large clini cal trials in
hypertension carotid disease atrial fibrillation and antithrombotic and antiplatelet
therapies have effectively demonstrated the efficacy of these targeted interventions in
reducing stroke incidence. More recently after earlier uncertainty regarding the role of
elevated lipids as a risk factor for stroke clinical trials of the statins have also
demonstrated a significant reduction in the incidence of ischemic stroke. However as em
phasized in Handbook of Stroke Prevention in Clinical Practice despite these gains and the
initial decline in stroke incidence that did occur in the 1960s and 1970s the incidence of
stroke disappointingly has failed to show a fur ther significant decline since that time. The
editors of Handbook of Stroke Prevention in Clinical Practice raise the very important question
of whether recognized strategies for stroke preven tion have been widely or effectively
implemented. They correctly empha size the critical importance of identifying the mechanism of
stroke in each patient so as to properly direct prevention and treatment. As Dr.
