BACKGROUND: Mild manifestations of individual cerebral small vessel disease (CSVD) markers are common and may not denote increased risk, but high CSVD burden identifies individuals at increased risk of stroke and dementia. Scores incorporating multiple individual CSVD markers may better identify a person's risk. We related a multimarker CSVD score to risk of incident stroke and compared it with the Framingham Stroke Risk Profile (FSRP) in community-dwelling individuals. METHODS: Framingham Heart Study participants aged ≥55 years, free of stroke and dementia, and with brain magnetic resonance imaging ratings of CSVD markers were included. A multimarker CSVD score reflecting increasing CSVD burden was used, assigning 1 point each for presence of cerebral microbleeds, severe perivascular spaces, extensive white matter hyperintensities, covert brain infarcts, and cortical superficial siderosis. Multivariable Cox proportional hazards regression analyses were used to relate CSVD score to incident stroke. RESULTS: Among 1154 participants (46% men, mean age 70.9±8.7 years), 92 (8%) developed stroke over a median follow-up of 8.6 years (Q1-Q3: 5.1-12.5). In models adjusting for age, sex, time interval between clinic exam and magnetic resonance imaging, Framingham cohort, and FSRP, those with ≥3 markers had increased risk of stroke (hazard ratio [HR], 2.62 [95% CI, 1.17-5.88]). In comparison, a 5% increase in FSRP was also associated with increased risk (adjusted HR, 1.16 [95% CI, 1.04-1.29]). The FSRP and CSVD score had similar model discrimination metrics. CONCLUSIONS: Higher CSVD burden is associated with increased risk of stroke, beyond the effect explained by risk factors in the FSRP. These findings support consideration of CSVD burden to identify risk of stroke in community-dwelling individuals for early implementation of preventive strategies.