Despite advances in strategies for the prevention and management of stroke, there is little direct feedback on their success at the population level and thus uncertainty regarding the ability to restrain a looming epidemic of stroke, especially in low to middle income countries which are undergoing rapid aging and adverse lifestyle changes.1 The paper by Cabral et al2 therefore provides a refreshingly positive outlook for the southern industrial city of Joinville, Brazil, where remarkable near one-third relative declines in the incidence, mortality rates and 30 day case fatality for stroke occurred in the past 10 years (see page 749). These data provide some reassurance that stroke can …