Advances in the clinical management of acute stroke in the past decade have led to more people surviving and living with less disability after stroke than before. However, secondary strokes, which are often more severe than the incident stroke, remain prevalent. In The Lancet Neurology, Christopher Schwarzbach and colleagues present the results of the SANO trial,1 a large, cluster-randomised trial that tested the effectiveness of a secondary prevention programme for reducing recurrent stroke rate.