In the Asymptomatic Carotid Artery Stenosis trial (1995), medical management was defined as aspirin in addition to adequate control of comorbidities. Since then, medical management of asymptomatic carotid artery stenosis (CAS) has progressed to include broader use of statins. Our purpose was to review the effect of contemporary medical management on stroke prevention. A retrospective review of the Kaiser Permanente, Southern California medical group database was performed. All patients with a diagnosis of asymptomatic CAS by International Classification of Diseases, 9th Revision codes from 2007 to 2011 were identified. Intervention for stroke prevention was the criteria for exclusion. Medications used were evaluated as was the rate of stroke. Asymptomatic CAS was noted in 7255 patients. Of these, 158 (2.2%) sustained a stroke within a mean follow-up of 37 months. Patients who were taking a statin had a statistically significant lower risk of stroke (1.6 vs 3.9%). The data support that contemporary medical management of asymptomatic CAS has decreased the incidence of stroke in comparison to previously published data. The use of statins was protective against the development of stroke. Future prospective randomized trials are needed to evaluate the efficacy of carotid intervention versus current medical management.