Coronary heart disease (CHD) and stroke frequently coexist, partly because they share many risk factors. After myocardial infarction (MI), there is a significant risk of mural thrombus formation, left ventricular aneurysm, impaired left ventricular function and atrial fibrillation; all these increase the risk of stroke. The risk of neurological deficit after cardiac surgery is higher in those patients who have already had a stroke. Cognitive decline after cardiac surgery is common: it may follow a pattern of early improvement but later decline. Lipid-lowering therapy has been shown to reduce non-fatal stroke in patients at risk of developing or with coronary artery disease. Clopidogrel with aspirin may be of benefit in patients with unstable angina and non-ST elevation MI. Antihypertensive treatment and stopping smoking are helpful. The HOPE trial results showed a powerful and preventative role for ACE inhibitors.