In this study this traditional diet was assessed in relation to coronary heart disease risk and its economic consequences, in a cross-sectional study with economic analysis. From May 2001 to December 2002 we randomly enrolled 1,514 adult men and 1,528 women, without any clinical evidence of cardiovascular disease. Adherence to the Mediterranean diet was ascertained through a food-frequency questionnaire and a special diet score that incorporated the inherent characteristics of this dietary pattern. The 10-year absolute risk for coronary heart disease was derived from the Framingham equations. Persons with a 10-year risk greater than 10% were considered as potential hospitalized patients. The health care cost of hospitalization due to an event was estimated in 690euro per patient. Of the participants who were "closer" to the Mediterranean diet (i.e., above the median diet score) and of those "away" from this dietary pattern, 4.2% and 39.8%, respectively, had a 10-year coronary risk greater than 10% (P < .001). Moreover, participants "closer" to the Mediterranean diet had a 43% (odds ratio = 0.57, 95% confidence interval 0.38 to 0.86) lower likelihood of having a 10-year coronary risk greater than 10%, after adjusting for potential confounders. Total health care cost was estimated to be 336.720euro in those who were "away" and 35.880euro in those who were closer to this diet pattern. Life-years lost due to disability was 6.8 in those who were "away" and 0.9 in those "close" to this pattern. The incremental cost-effectiveness ratio was 50.989euro (i.e., the additive health care cost due to an unhealthy diet for each year lost). The implementation of the Mediterranean dietary pattern may lead to an improvement in life expectancy, a net gain to health, and a reduction in total lifetime costs.