Background—Several studies have documented an inverse association between adherence to the Mediterranean diet and risk of coronary heart disease (CHD), but few data are available on the relationship between Mediterranean diet and risk of stroke.

Methods and Results—For the present study, 74 886 women 38 to 63 years of age in the Nurses' Health Study, a cohort study of female nurses, without a history of cardiovascular disease and diabetes were followed up from 1984 to 2004. We computed an Alternate Mediterranean Diet Score from self-reported dietary data collected through validated food frequency questionnaires administered 6 times between 1984 and 2002. Relative risks for incident CHD, stroke, and combined fatal cardiovascular disease were estimated with Cox proportional-hazards models adjusted for cardiovascular risk factors. During 20 years of follow-up, 2391 incident cases of CHD, 1763 incident cases of stroke, and 1077 cardiovascular disease deaths (fatal CHD and strokes combined) were ascertained. Women in the top Alternate Mediterranean Diet Score quintile were at lower risk for both CHD and stroke compared with those in the bottom quintile (relative risk [RR], 0.71; 95% CI, 0.62 to 0.82; P for trend<0.0001 for CHD; RR, 0.87; 95% CI, 0.73 to 1.02; P for trend=0.03 for stroke). Cardiovascular disease mortality was significantly lower among women in the top quintile of the Alternate Mediterranean Diet Score (RR, 0.61; 95% CI, 0.49 to 0.76; P for trend<0.0001).

Conclusion—A greater adherence to the Mediterranean diet, as reflected by a higher Alternate Mediterranean Diet Score, was associated with a lower risk of incident CHD and stroke in women.