Lifestyle modification, particularly dietary changes, is the cornerstone of population-based strategies for cardiovascular disease (CVD) prevention.1 Recently the Prevención con Dieta Mediterránea (PREDIMED) study,2 a 5-year randomized primary prevention trial (isrctn.org Identifier: ISRCTN35739639), showed a 30% reduction in incident CVD with Mediterranean diet (MeDiet) intervention in comparison with a control diet. At quarterly visits throughout the study, a validated 14-item MeDiet screening tool (Table 1) was used to assess conformity with this dietary pattern.3 Close monitoring of adherence to dietary instructions for CVD prevention is difficult in the clinical setting. Short dietary assessment tools, such as the PREDIMED screener, are desirable to identify individuals in need of dietary counseling. Given that there is little information on the association of diet scores with disease outcomes in longitudinal studies, we investigated whether the baseline 14-point MeDiet score was related to incident CVD in the PREDIMED cohort