Objective: Poor compliance with evidence-based medicine guidelines could significantly influence the effect of stroke prevention strategies. The objective of this survey is to evaluate the current status of adherence to secondary prevention guidelines based on evidence-based medicine and related lifestyle modifications, both at hospital discharge and 90 days after discharge for inpatients with atherosclerotic cerebral infarction/transient ischemic attack (TIA) in Beijing. Methods: The survey enrolled patients with cerebral infarction/TIA, from seven hospitals in Beijing consecutively from 1 October 2006 to 1 May 2007, and was designed to record detailed information including ACEI/ARB, statins, anti-platelet agent therapy, carotid endarterectomy, angioplasty or stent, smoking and weight control behaviors. Results: Seven hundred and eight cerebral infarction/TIA inpatients had been enrolled over the past 7 months from the year of 2006 to 2007. The proportion of patients with ischemic stroke that have not taken any anti-platelet agents, statins and ACEI/ARB were 0.4, 41.8 and 63.6%, respectively. Twenty-seven percent of the total patients have not followed the instructions on quitting tobacco. Five hundred and eighty-eight patients who are suitable to have drug therapy were followed up 90 day after discharge: 26.9% have not adhered to anti-platelet agents; 52.6% have not been treated by statins, and 59.4% have not had ACEI/ARB to lower blood pressure. Only 66.9% of the smokers have been instructed by clinicians on smoking cessation at the time of discharge. Conclusion: The current status of drug therapy and life modification for secondary prevention on ischemic stroke and TIA in Beijing, China, is still very challenging. Clinicians should pay more attention to the patients' adherence to secondary stroke prevention guidelines, to enhance the effectiveness of stroke prevention through filling the gap between the clinical practice and evidence.