The current mortality and morbidity attributable to cerebrovascular disease is of concern nationally and globally. Moreover, the overall burden of stroke is expected to increase over the next two to four decades. More people will reach older age, when the risk of stroke rises sharply,1 and this will offset the fall in the age specific incidence of stroke reported by recent epidemiological studies.2 3 In the linked study (doi:10.1136/bmj.b349), Myint and colleagues prospectively assess the relation between lifestyle behaviours and incident stroke in a cohort of 20 040 men and women aged 40-79 years.4

How should individuals, policy makers, and society respond to this challenge? Benjamin Franklin said that an ounce of prevention is worth a pound of cure, and fortunately stroke is both predictable and preventable. More than 15 years ago, the Framingham stroke risk score—based on age, blood pressure, use of antihypertensives, diabetes mellitus, cigarette smoking, previous cardiovascular disease, atrial fibrillation, and left ventricular hypertrophy—was derived to calculate an individual’s risk and “provide the impetus …