Background Few studies have examined the association between global diet, assessed through dietary patterns, and arterial structure and function. The aim of this study was to investigate the relationship between carotid-femoral pulse-wave velocity (PWV), common carotid-arteries intima-media thickness (CCA-IMT) and plaques with dietary patterns measured 7.5 years earlier. Design A prospective cohort study between diet and markers of structure and function of large arteries. Methods Dietary patterns (linear combination of food consumption) were identified using principal component analysis among 1026 middle-aged participants in the SUpplementation en VItamines et Mineraux AntioXydants (SU.VI.MAX) vascular substudy. Dietary data were based on repeated 24-h dietary records (at least three records during 2 years) obtained at inclusion. Carotid-femoral PWV was used to assess aortic stiffness. Carotid ultrasound examination included measurements of CCA-IMT and carotid plaques. Results Four dietary patterns were identified. In multivariate models, a significant positive association was observed between PWV and a dietary pattern positively correlated with meat and alcohol consumption and negatively correlated with fibers, vitamins B9 and C, beta-carotene and calcium consumption. Adjusted PWV mean across tertiles of this pattern score was 11.15, 11.26 and 11.58 m/s in the first, second and third tertiles, respectively (P for trend=0.03). Others dietary patterns were not associated with PWV and we detected no association between dietary patterns and IMT or plaques. Conclusion This study suggests that a nutritionally poor dietary pattern, characterized by a high meat and alcohol consumption and low micronutrients intake, is related to an increased stiffening of large arteries. Eur J Cardiovasc Prev Rehabil 17:718-724 (C) 2010 The European Society of Cardiology