Beyond the quantity of carbohydrate intake, further research is needed to know the relevance of carbohydrate quality following operational indices. No previous longitudinal study has assessed the association between an index for quality of dietary carbohydrate intake and the risk of cardiovascular disease (CVD). Here, we examined the association between a carbohydrate quality index (CQI) and the risk of CVD.We used a validated semi-quantitative 136-item food-frequency questionnaire (FFQ) in a prospective follow-up study of 17,424 middle-aged adults from Spain. The CQI was defined by four criteria: dietary fiber intake, glycemic index, whole-grain/total-grain carbohydrate ratio, and solid/total carbohydrate ratio. We observed 129 incident cases of CVD during 10.1 y of median follow-up. An inverse association for CQI was found (hazard ratio = 0.44, 95% confidence interval (CI): 0.25-0.78 for the highest versus the lowest tertile, p for trend = 0.008). Participants in the highest tertile of the whole-grain/total-grain carbohydrate ratio had 47% lower risk of CVD (95% CI: 0.33-0.85, p for trend = 0.008). Participants with higher baseline CQI and higher baseline energy from carbohydrates had the lowest risk of CVD.In this Mediterranean cohort, a better quality of dietary carbohydrates measured by the CQI, showed a significant inverse association with the incidence of CVD. Specially, a higher proportion of carbohydrates from whole grains was strongly inversely associated with CVD. "Heart-healthy" diets should be focused not only on carbohydrate quantity but also on a multidimensional assessment of the type and quality of carbohydrates.