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Survival and recurrences after stroke were assessed prospectively in a general population sample of 5184 subjects followed biennially for 26 years. Initial strokes occurred in 198 men and 196 women. There were 84 second and 27 third strokes and 223 deaths reported. Thirty day case-fatality rates for initial strokes were: 15% (33/222) for brain infarction, 16% (10/63) for cerebral embolus, 46% (18/39) for subarachnoid hemorrhage, and 82% (14/17) for intracerebral hemorrhage. Cumulative, age-adjusted 5 year survival rates for brain infarction were reduced by pre-stroke cardiac disease (coronary heart disease and/or congestive heart failure) and hypertension prior to initial stroke from .85 to .35 in men and .70 and .56 in women. Hypertension alone reduced survival from .85 to .51 in men, but not in women. Recurrences were primarily of the same type as the initial stroke. Cumulative 5 year recurrence rate for brain infarction was .42 for men, almost double that for women. Rates were reduced by excluding hypertensives and those with combined cardiac comorbidity and hypertension. Thus, risk of death or recurrence after stroke is substantial and profoundly influenced by sex and by cardiac comorbidity and hypertension present prior to the initial event.