Some cardiovascular risk factors are more prevalent in Middle Eastern countries than in other parts of the world. Lifestyle-related factors, including diet, might account for this discrepancy. We aimed to identify the association between food intake patterns and cardiovascular risk factors among Iranian adult women. We studied 486 apparently healthy Iranian women aged 40-60 y. We used a Willett-format FFQ for collecting dietary data. Fasting plasma glucose (FPG) concentrations, lipid profiles, and blood pressure were measured. Diabetes was defined as FPG > or = 6.93 mmol/L; dyslipidemia was based on Adult Treatment Panel III and hypertension on Joint National Committee VI recommendations. The presence of at least 1 risk factor and at least 2 risk factors of the 3 major risk factors for cardiovascular disease (hypertension, dyslipidemia, and diabetes) was also evaluated. We identified 3 major eating patterns (healthy, Western, and Iranian). After controlling for potential confounders, subjects in the top quintile of the healthy dietary pattern were less likely to have dyslipidemia [odds ratio (OR), 0.36; 95% CI, 0.19-0.53], hypertension (OR, 0.33; 95% CI, 0.17-0.60), at least 1 (OR, 0.30; 95% CI, 0.18-0.58), and at least 2 risk factors (OR, 0.39; 95% CI, 0.20-0.77) compared with the lowest quintile. In contrast, those with greater adherence to the Western dietary pattern had greater odds for cardiovascular risk factors (OR, 2.59-3.11; P < 0.05). The Iranian dietary pattern was significantly associated with dyslipidemia (OR, 1.73; 95% CI, 1.02-2.99) and at least 1 risk factor (OR, 1.89; 95% CI, 1.05-3.20). The major dietary patterns and diabetes were not associated. Eating patterns of this Middle Eastern population might explain the higher prevalence of some cardiovascular risk factors in this region. However, our findings need to be confirmed in other Middle Eastern countries.