OBJECTIVE. Stroke accounts for a significant degree of morbidity, mortality, and health care expenditure in this nation despite the many medical and surgical preventive measures we have in place. This article discusses how developing a universally accepted effective screening examination will help decrease this health care burden. Risk factors for the development of cardiovascular disease are explored. Special attention is given to the pathogenesis and diagnosis of carotid atherosclerosis because it accounts for a large percentage of both embolic and ischemic strokes. Current diagnostic testing, in particular duplex carotid sonography, and proposed screening strategies for the detection of carotid atherosclerosis and other risk factors are reviewed. Sex-related differences proposed in the current literature are also explored in this article because they may affect how we screen for and prevent stroke.; CONCLUSION. Developing an accurate, cost-effective, and universally acknowledged screening test will allow us to maximize the preventive medical and surgical measures we already have in place. Doing so will in turn lead to a significant decrease in the morbidity, mortality, and health care expenditure associated with stroke.