Serum cholesterol levels have been associated with atherosclerosis and the lowering of serum cholesterol with hydroxy-methyl coenzyme A reductase inhibitors, or statins, has been shown to decrease cardiovascular events. Though early epidemiologic data found conflicting results regarding serum cholesterol levels and stroke, randomized clinical trials of statins for coronary heart disease prevention showed a clear reduction in the incidence of stroke. This review summarizes the clinical trial data surrounding lipid lowering for stroke prevention while also exploring potential mechanisms for such an effect. Particular attention is given to trials for primary and secondary prevention of stroke relevant to the hypertensive individual, and the impact of hemorrhagic vs. ischemic stroke in the outcomes of these trials.