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Introduction: Severity of leukoaraiosis, or white matter hyperintensity (WMH) detected on T2 MRI, is associated with cognitive and functional decline and is a known risk factor for stroke and poor post-stroke outcomes. Fazekas score is a validated ordinal scale that accounts for WMH severity in the individual categories of periventricular (PVWM), deep WMH extent (DWMH) and deep WMH number of lesions (DWMNUM). Vascular risk factors (VRFs) are hypothesized to have differential effect on WMH lesion pathophysiology. We tested whether the Framingham Stroke Risk Score (FSRS), a collective score of several VRFs, is associated with WMH severity across individual Fazekas categories in a hospital-based cohort of patients with acute ischemic stroke (AIS).Methods: In 294 AIS patients, WMH was categorized into PVWM, DWMH, DWMNUM, and an average of all three categories per subject (“the condensed score”). Fazekas scores ranging 0-3 in each category were dichotomized (mild WMH≤1 vs. severe WMH ≥2). FSRS was calculated for each patient using a standardized formula awarding points for each FSRS variable (age, gender, systolic blood pressure, diabetes mellitus, cigarette smoking, coronary heart disease, left ventricular hypertrophy, atrial fibrillation) and added to obtain a total FSRS, which was then categorized into multiples of ten (FSRS ≥10, FSRS ≥20). Logistic regression models included binary FSRS category and Fazekas score for each WMH category using Stata 12.Results: As compared to AIS subjects with FSRS<20, those with FSRS≥20 had greater odds of severe leukoaraiosis across all four WMH categories (Figure).Conclusions: In our cohort, FSRS predicts severity of leukoaraiosis across different Fazekas categories, suggesting compounded effect on WMH development from various VRFs comprising the FSRS. Future studies powered to discern the effect of individual elements of FSRS on WMH categories are warranted to further understand the pathophysiology of leukoaraiosis.