Background: Limited data are available on the association of major dietary patterns and predicted risk of cardiovascular disease (CVD) using the Framingham Risk Score (FRS). Aim: To investigate the association between major dietary patterns and the predicted 10-year CVD risk in an Iranian population Methods: This cross-sectional study was conducted on 522 apparently healthy adults referred to health centers in Tehran. Usual dietary intake was assessed using a validated semi-quantitative food frequency questionnaire. The association between dietary patterns and the predicted risk of development of CVD was evaluated using linear multiple regression. Principal component analysis was used to identify major dietary patterns. Results: In total, 41% of the men ( n = 95) and 46% of women ( n = 134) were in the low risk (<10%) and 6% of men ( n = 14) and 1% of women ( n = 3) were in the high risk (> 20%) category of the FRS. A significant decrease was found for body mass index ( p < 0.001), systolic blood pressure (SBP) ( p = 0.003), diastolic blood pressure ( p = 0.005), and triglyceride ( p = 0.02) in the higher tertile of healthy dietary pattern. Adherence to an unhealthy dietary pattern was associated with a significant increase in body weight ( p = 0.03) and a significant decrease in high-density lipoprotein cholesterol ( p < 0.001). The healthy dietary pattern score was negatively associated with SBP ( p = 0.04) and FRS ( p < 0.001). Conclusion: Although we observed improvements in CVD risk factors with greater adherence to healthy dietary patterns, there was no association between identified dietary patterns and the predicted risk of 10-year CVD.