Stroke is a major public health issue in China, with over 2 million new cases annually, making it the leading cause of disability-adjusted life-years lost. The burden is expected to rise due to aging populations, high prevalence of risk factors like hypertension, and inadequate management. Despite improved access to services, specialist stroke care is uneven, especially in rural areas. In-hospital outcomes have improved with better reperfusion therapies and supportive care, but adherence to secondary prevention and long-term care remains poor. Thrombolysis and stroke units are standard, but concerns about bleeding risk and organizational challenges limit their adoption. Chinese herbal products and neuroprotective agents are widely used, but over-diagnosis and over-treatment of silent strokes are increasing due to better neuroimaging. Future efforts should focus on balanced stroke services, evidence-based practices, and translational research. Stroke is the second leading cause of death globally and the leading cause in China, where one-fifth of the world's population resides. A previous review called for more research to update knowledge on stroke burden and practices. Over the past decade, research on stroke in China has increased, leading to better understanding of its causes and prevention. Evidence-based care has been integrated into the healthcare system, with improved in-hospital outcomes despite rising prevalence and incidence. This review updates the epidemiology, prevention, and management of stroke in China. It focuses on modifiable risk factors and affordable interventions. It identifies gaps in evidence-based care delivery and explores variations in stroke care across the country. Based on current progress and challenges, it provides suggestions for policymakers and healthcare providers to reduce the rising burden of stroke. Nationwide studies show a high and increasing stroke burden in China. The National Stroke Epidemiology Survey (NESS-China) reported an age-standardized stroke prevalence of 1115/100,000, with annual incidence and mortality of 247 and 115, respectively. These data indicate an estimated 11 million prevalent cases, 2.4 million new strokes, and 1.1 million stroke-related deaths annually in China. The China National Stroke Screening Survey reported higher stroke prevalence and incidence in older populations compared to the NESS-China study. These data highlight a marked increase in stroke prevalence and incidence, with generally stable mortality compared to previous rates. Risk factors for stroke in China include hypertension, dyslipidaemia, diabetes, smoking, alcohol consumption, air pollution, low fruit and vegetable intake, and high sodium intake. Hypertension is the most significant modifiable risk factor, affecting 300 million adults in China between 2013-2014. The prevalence of hypertension is highest in Northern and Eastern China. Despite improved awareness and treatment, less than 20% of patients have controlled hypertension, lower than in the UK and US. Dyslipidaemia and diabetes are also prevalent and poorly controlled in China, both associated with increased stroke riskStroke is a major public health issue in China, with over 2 million new cases annually, making it the leading cause of disability-adjusted life-years lost. The burden is expected to rise due to aging populations, high prevalence of risk factors like hypertension, and inadequate management. Despite improved access to services, specialist stroke care is uneven, especially in rural areas. In-hospital outcomes have improved with better reperfusion therapies and supportive care, but adherence to secondary prevention and long-term care remains poor. Thrombolysis and stroke units are standard, but concerns about bleeding risk and organizational challenges limit their adoption. Chinese herbal products and neuroprotective agents are widely used, but over-diagnosis and over-treatment of silent strokes are increasing due to better neuroimaging. Future efforts should focus on balanced stroke services, evidence-based practices, and translational research. Stroke is the second leading cause of death globally and the leading cause in China, where one-fifth of the world's population resides. A previous review called for more research to update knowledge on stroke burden and practices. Over the past decade, research on stroke in China has increased, leading to better understanding of its causes and prevention. Evidence-based care has been integrated into the healthcare system, with improved in-hospital outcomes despite rising prevalence and incidence. This review updates the epidemiology, prevention, and management of stroke in China. It focuses on modifiable risk factors and affordable interventions. It identifies gaps in evidence-based care delivery and explores variations in stroke care across the country. Based on current progress and challenges, it provides suggestions for policymakers and healthcare providers to reduce the rising burden of stroke. Nationwide studies show a high and increasing stroke burden in China. The National Stroke Epidemiology Survey (NESS-China) reported an age-standardized stroke prevalence of 1115/100,000, with annual incidence and mortality of 247 and 115, respectively. These data indicate an estimated 11 million prevalent cases, 2.4 million new strokes, and 1.1 million stroke-related deaths annually in China. The China National Stroke Screening Survey reported higher stroke prevalence and incidence in older populations compared to the NESS-China study. These data highlight a marked increase in stroke prevalence and incidence, with generally stable mortality compared to previous rates. Risk factors for stroke in China include hypertension, dyslipidaemia, diabetes, smoking, alcohol consumption, air pollution, low fruit and vegetable intake, and high sodium intake. Hypertension is the most significant modifiable risk factor, affecting 300 million adults in China between 2013-2014. The prevalence of hypertension is highest in Northern and Eastern China. Despite improved awareness and treatment, less than 20% of patients have controlled hypertension, lower than in the UK and US. Dyslipidaemia and diabetes are also prevalent and poorly controlled in China, both associated with increased stroke risk