Stroke and coronary heart disease (CHD) share many risk factors, suggesting at least some similarities in pathogenesis. It is therefore surprising that the role of one of the major risks for CHD, dyslipidaemia, remains so contentious as a risk factor for stroke. Because of a lack of good clinical trials, conflicting views have been expressed on the association of lipids, primarily serum cholesterol and its subfractions, with stroke disease and the merits of preventing stroke by lowering cholesterol. Many of the issues involved are intimately related to those of managing dyslipidaemia in the elderly. If stroke occurred as commonly below the age of 65 as above this age it is likely that the necessary epidemiological and intervention studies would already have been undertaken.