BACKGROUND Conventional risk factors for coronary heart disease (CHD) and ischaemic stroke (IS) have been well documented. This study examines whether there is a unique pattern of risk factors for each disease. METHODS This is a prospective cohort study in Dubbo NSW which has followed 2805 men and women 60 years and older for 16 years since 1988-1989. CHD and IS events were identified by hospital record linkage. The independent contributions of risk factors to these events were evaluated in proportional hazards regression models. RESULTS CHD events (without stroke) occurred in 853 subjects (30.4/100). IS events (without CHD) occurred in 185 subjects (6.6/100). Some risk factors produced broadly similar prediction of CHD and IS events (male sex, current smoking, diabetes, LDL cholesterol, reduced peak expiratory flow, physical disability). Other factors potentially produced unique prediction of CHD (CHD at baseline, family history of CHD, HDL cholesterol, ApoB/ApoA1 ratio) or IS (stroke at baseline), or stronger prediction of IS compared with CHD (age, hypertension, atrial fibrillation). CONCLUSIONS CHD and IS may each have some unique predictors, but treatable risk factors have been demonstrated for both cardiovascular outcomes.