Stroke presents an important health problem which has an impact at personal, social and public health levels and exerts a major influence on the morbidity, mortality and healthcare costs of most populations. This article reviews the primary, secondary and tertiary interventions that could reduce the incidence or burden of stroke in the general population.A systematic (MEDLINE) computer search of the literature and review of the relevant information using standard techniques was used to assess the validity. importance and appropriateness of the evidence. This basic approach was supplemented with more detailed searches for relevant randomised trials.The results showed that primary prevention should be directed at the major risk factors of hypertension. smoking, diabetes mellitus, atrial fibrillation and lifestyle. We currently have evidence to support primary prevention treatment of hypertension, smoking cessation and antithrombotic treatment in atrial fibrillation. Secondary prevention measures with good evidence of benefit include the routine use of aspirin (acetylsalicylic acid), anticoagulation in atrial fibrillation and surgery for severe, symptomatic carotid stenosis. There is evidence to support organised (stroke unit) care to reduce the impact of stroke disease (tertiary prevention).Maximising health outcomes at a population level will need to include primary prevention directed at common risk factors, secondary prevention in high-risk individuals, and organised services for those who have suffered a stroke.