Background and Purpose: Genetic polymorphisms in ABC transporter A1 (ABCA1) may alter the regulation of plasma high-density lipoprotein (HDL), promoting or protecting from vascular diseases. Methods: We investigated 244 unrelated, consecutively enrolled patients with ischemic stroke, 150 patients with coronary heart disease (CHD) and 193 blood donors for allele frequencies (AFs) of three common ABCA1 polymorphisms (R219K, V771M and I883M). Results: Compared to controls (30.8 ± 4.7 and 4.9 ± 2.2%, respectively), decreased AFs were found in both patient groups for R219K and V771M (28.7 ± 4.1 and 3.1 ± 1.6% in stroke, and 25.7 ± 5.0%; 1.3 ± 1.3% in CHD patients, respectively). In a subset of stroke patients younger than 50, both variants occurred in significantly lower frequencies (22.4 ± 5.5 and 1.8 ± 1.7%, respectively). Similarly, among CHD patients younger than 60, AFs of R219K and V771M (22.6 ± 7.5 and 0 ± 1.6%, respectively) were decreased. V771M was almost exclusively (35/36) found in individuals carrying the R219K allele. Conclusions: Our data confirm earlier observations that ABCA1 R219K and V771M polymorphisms may be associated with a protective role against CHD and extend those to another important pathologic condition, namely stroke.