Aparicio HJ, et al. - In a community sample stratified by stroke onset at a middle and older age, researchers studied long-term trends in ischemic stroke incidence and changes in stroke risk factors. Surveillance for incident stroke is ongoing since 1948 as part of the Framingham Study. Atherosclerotic brain infarction or cardioembolism were the causes of most ischemic strokes in midlife. In the community sample, long-term ischemic stroke rates declined, and the decline in older adults was higher vs younger adults. Sustained declines in the incidence of strokes and midlife mortality depend on early prevention, which requires a focus on modifying cardiovascular risk factors.