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To investigate age- and sex-specific trends in incidence of and mortality from ischaemic stroke (IS) in the Netherlands.Descriptive study and cohort study.Data from the cause-of-death statistics from Statistics Netherlands, the Dutch national medical registry and local council population registers were used. A cohort of IS patients was formed by linking these registers. Age- and sex-specific trends in mortality from IS in the period 1980-2010 were determined using 'join point' regression analysis. The 30-day and 1-year mortality rates following hospital admission for IS and the incidence of new cases of IS were calculated for the cohort of IS patients. Mann-Kendall tests were used for trend analysis over the period 1997-2005.Rates of mortality from IS decreased gradually in the period 1980-2000, with the exception of a levelling out of the rate of decrease in a few age groups in the 1990 s. Decrease in mortality declined dramatically after 2000 in all age groups, except for male patients in the age range 35-64 years. A comparative increased rate of decrease after 2000 was observed for 30-day and 1-year mortality following hospital admission for IS. The incidence of IS remained constant in the period 1997-2005, or increased in a few age groups.Mortality rates following IS have decreased dramatically in the Netherlands since 2000. However, the number of cases of non-fatal IS has not decreased and is actually increasing slightly, indicating that more people have experienced IS. This is a concern, since IS often leads to disability with the accompanying burden of disease and economic burden. Prevention of IS is, therefore, extremely important.