Introduction:White matter hyperintensities (WMH) and cerebral microbleeds (CMB) are manifestations of small vessel disease (SVD), a surrogate for vascular cognitive impairment. Few studies have systematically investigated the racial differences in SVD among African American (AA) and white stroke/TIA patients.Methods:MRI scans of consecutive ischemic stroke and TIA patients admitted to our tertiary stroke center were assessed as a part of a stroke study. Deep and periventricular WMHs (DWMHs and PVWMHs, respectively) were rated visually on axial FLAIR images using the 4-point Fazekas scale and categorized into none/mild (grades 0 and 1) or moderate/severe (grades 2 and 3). Subsequently T2*-weighted MRI scans for the number, location, and topography of CMBs, as well as patients’ demographic, clinical information, and periodontal disease (PD) were evaluated. Student t-tests were performed to test continuous variables. X2tests were used to compare categorical variables. Multivariable analysis using multiple logistic regression was used to test the association between AA and SVD.Results:Among a total of 861 consecutive patients (741 stroke, 120 TIA), 469 AA patients were compared with 360 white for moderate/severe PVWMH (38%), DWMH (32%) and CMB≥5 (3%). Those with moderate/severe PVWMH were older (age 68±11 vs. 61±12, p<0.001), more likely to be male (42% vs. 35%, p=0.02), hypertensive (40% vs. 26%, p=0.02), diabetic (43% vs. 34%, p=0.007), and have severe PD (41% vs. 35%, p=0.07). AA race was associated with PVWMH (Adj. OR 1.9, 95% 1.4-2.7) when adjusted for age, gender, hypertension, diabetes, and PD. Those with moderate/severe DWMH were older (age 68±10 vs. 62±13, p<0.001), and more likely to be hypertensive (33% vs. 24%, p=0.09), diabetic (37% vs. 27%, p=0.003), and have severe PD (36% vs. 28%, p=0.01). AA race was associated with DWMH (Adj. OR 1.5, 95% 1.1-2.2) when adjusted for age, hypertension, diabetes, and PD. Those with CMB≥5 were more likely to be hypertensive (5% vs. 1%, p=0.008). AA race was associated with CMB≥5 (Adj. OR 4.1, 95% 1.3-12.6) when adjusted for age and hypertension.Conclusion:We report significant independent association between AA race and various manifestations of SVD including moderate/severe DWMH, PVWMH, and CMB≥5.