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Objectives To examine the association between successful aging without subsequent cognitive decline ( SA- ND) and the Northern Manhattan Study ( NOMAS) global vascular risk score ( GVRS), which is predictive of stroke, myocardial infarction, and vascular death. Design Prospective cohort study. Setting A stroke-free sample of Hispanic, black, and white participants living in the same community enrolled in a magnetic resonance imaging ( MRI) substudy of NOMAS, a population-based prospective cohort study. Participants One thousand two hundred ninety individuals in whom a cognitive screen was administered at baseline and at enrollment in the MRI substudy. Measurements SA- ND was based on disease, disability, and cognitive function. The GVRS includes age, sex, race and ethnicity, waist circumference, alcohol intake, smoking, physical activity, blood pressure, antihypertensive medication use, fasting blood sugar, lipid levels, and peripheral vascular disease. Results Data at baseline and follow-up were available for 1,162 participants (mean age 70 ± 9; 61% women; 13% white, 16% black, 69% Hispanic; mean GVRS 8.6 ± 0.9). Logistic regression, adjusted for education, socioeconomic status, and follow-up time, showed that the odds of SA- ND were 38% greater for each additional 1-point decrease on the GVRS (odds ratio = 1.38, 95% confidence interval = 1.17-1.61; P < .001). An inverse dose-response was observed between quartiles of GVRS and SA- ND. Greater diastolic blood pressure in participants taking antihypertensive medication and a history of claudication ( P = .003) or peripheral arterial disease ( P < .001) were inversely associated with SA- ND in the fully adjusted model. Conclusion Potentially modifiable vascular risk factors were independently associated with SA- ND in a multiethnic community-based sample. Improvements in GVRSs could help promote healthy longevity in the aging population. [ABSTRACT FROM AUTHOR]