Background We investigated the association between family history of stroke (FHS) and Life's Simple 7 (LS7), a public health metric defined by the American Heart Association. Methods Reasons for Geographic and Racial Differences in Stroke is a national population-based cohort of 30,239 blacks and whites, aged 45 years or older, sampled from the US population between 2003 and 2007. Data were collected by telephone, mail questionnaires, and in-home examinations. FHS was defined as any first-degree relative with stroke. Levels of the LS7 components (total cholesterol, blood pressure, fasting glucose, physical activity, diet, smoking, and body mass index) were each coded as poor (0 points), intermediate (1 point), or ideal (2 points) health. Ordinal logistic regression was used to model the data. Results Among 20,567 subjects with complete LS7 and FHS data, there were 7702 (37%) participants with an FHS. The mean age of the participants was 64 years. The mean (± standard deviation) overall LS7 score was lower for blacks (6.5 ± 2.0) than that of whites (7.6 ± 2.1). FHS was associated with poorer levels of physiological factors, particularly high blood pressure (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.07-1.19) and inversely associated with behaviors such as smoking (OR,.92; 95% CI,.85-.99). Conclusions Our results suggest that screening for FHS can provide an opportunity for earlier detection and management of modifiable risk factors.