This article presents death rates for cerebrovascular disease (stroke) by sex for ages 35 to 74 years in 1990 for 52 countries, and trends in rates from 1950 to 1990 for 30 countries. Rates are high in Asia and eastern Europe. In most industrialized countries, large declines occurred, particularly over the last 2 decades. The United States and Canada have low rates. Portugal, Trinidad, Paraguay, Mauritius, China, Korea, and most eastern European countries have the highest rates. Japan, with very high stroke mortality in the 1950s, experienced the largest absolute and percent decline and now ranks above western Europe and North America but below most other countries. In most industrialized countries, except in eastern Europe, stroke death rates declined more than 50% since 1970, somewhat more in women than in men. There is more uniformity in trends since 1970 than in earlier years. In several countries, either a downward slope accelerated in the 1970s, or a rising trend was reversed.