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Whether stroke survivors can meet risk factor recommendations set by guidelines is unknown. We investigated the proportion of stroke survivors that met the secondary prevention guideline recommendations, analyzed the trends over time, and assessed the impact on mortality. Using cross-sectional data on stroke survivors from the National Health and Nutrition Examination Survey (NHANES) from 1999-2018, we determined the proportion of stroke survivors who met guideline recommendations. We performed linear regression analyses to determine trends and performed Cox-proportional hazards models to assess mortality. We included 2197 stroke survivors (51% female, mean age 68). Most patients met guidelines set for alcohol consumption (93% [95% CI 91-95]), while few met the thresholds for physical activity (18% [95% CI 15-30]) or BMI (25% [95% CI 22-27]). The proportion that met guidelines for blood pressure (+1.4% every 2 years) and LDL (+3.0%) increased, while the proportion that met physical activity guidelines decreased (-1.1%). Mortality was increased in those that did not meet recommendations regarding blood pressure (HR 1.24 [95% CI 1.04-1.48]) and smoking (HR 1.30 [95% CI 1.03-1.64]). More than half of stroke survivors do not meet recommendations set by prevention guidelines on BMI, physical activity and LDL.