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BACKGROUND: Stroke and dementia are leading causes of mortality and can be prevented through risk factor management. Risk factor assessment requires laboratory or physical measurements. We aimed to determine whether self-reported risk factors serve as reliable proxies and predict stroke- and dementia-related mortality.METHODS AND RESULTS: We used cross-sectional data from the NHANES (National Health and Nutrition Examination Survey) from 1999 to 2018 linked to National Death Index records. We included participants with available data on self-reported and measured hypertension, hypercholesterolemia, diabetes, kidney disease, hearing impairment and overweight. Reliability was assessed using F1 scores, and used survey-weighted Cox-proportional hazards models evaluated associations with stroke- or dementia-related mortality. Reliability of self-reported risk factors was highest in overweight (F1 score 0.81, sensitivity 76%, specificity 77%) and diabetes (F1 score 0.71, sensitivity 77%, specificity 97%) and lowest for kidney disease (F1 score 0.25, sensitivity 16%, specificity 98%). Self-reported hypertension (hazard ratio [HR], 1.49 [95% CI, 1.14-1.94]) and diabetes (HR, 1.58 [95% CI, 1.18-2.12]) were associated with stroke-related mortality, comparable to measured risk factors. For dementia-related mortality, only measured hearing impairment (all dementia cases had hearing impairment at baseline) and both self-reported (HR, 0.50 [95% CI, 0.37-0.68]) and measured overweight (HR, 0.70 [95% CI, 0.52-0.93]) were associated.CONCLUSIONS: In conclusion, the reliability and validity of self-reported risk factors for stroke and dementia differ between risk factors. Although self-reported measures vary in their reliability, they perform equally as well as objective metrics for evaluating the risk of stroke- and dementia-related mortality.