BACKGROUND AND PURPOSE-: We aimed to describe the uptake of proven secondary prevention strategies for ischemic stroke in urban China. METHODS-: In a prospective, multicenter, hospital-based registry of 4782 cases of acute ischemic stroke in China during 2006, the use of secondary prevention regimens was evaluated before hospital discharge and 3 and 12 months after stroke. Logistic regression analysis was performed to determine associations between various baseline variables and in-hospital use of antihypertensive, antiplatelet, and lipid-lowering therapies, and to identify variables associated with their continuation at 12 months. RESULTS-: In-hospital initiation of antihypertensive (63%), antiplatelet (81%), and lipid-lowering (31%) therapies was influenced favorably by previous use and comorbid cardiovascular risk factors and unfavorably by stroke severity. Antihypertensive use was well-maintained during follow-up, whereas use of antiplatelet and lipid-lowering therapy decreased (66% and 17%, respectively; P<0.001) by 12 months after stroke, with discontinuation related to patient and physician factors. INTERPRETATION-: There was a high level of uptake of secondary prevention for ischemic stroke in this nationwide sample of hospitalized patients in urban China. However, use of antiplatelet and lipid-lowering therapy declined substantially after discharge, apparently related to misperceptions of subsequent disease risk by both doctors and patients.