| Summary: | Recently, diets with higher inflammatory potentials based on the dietary inflammatory index (DII<sup>®</sup>) have been shown to be associated with increased cardiovascular disease (CVD) risk in the general population. We aimed to prospectively investigate the association between the DII and CVD risk in the large Korean Genome and Epidemiology Study_Health Examination (KoGES_HEXA) cohort comprised of 162,773 participants (men 55,070; women 107,703). A validated semi-quantitative food frequency questionnaire (SQ-FFQ) was used to calculate the DII score. Statistical analyses were performed by using a multivariable Cox proportional hazard model. During the mean follow-up of 7.4 years, 1111 cases of CVD were diagnosed. Higher DII score was associated with increased risk of CVD in men (hazard ratio [HR]<sub>Quintile 5 vs. 1</sub> 1.43; 95% CI 1.04−1.96) and in women (HR<sub>Quintile 5 vs. 1</sub> 1.19; 95% CI 0.85−1.67), although not significant for women. The risk of CVD was significantly higher in physically inactive men (HR<sub>Quintile 5 vs. 1</sub> 1.80; 95% CI 1.03−3.12), obese men (HR<sub>Quintile 5 vs. 1</sub> 1.77; 95% CI 1.13−2.76) and men who smoked (HR<sub>Quintile 5 vs. 1</sub> 1.60; 95% CI 1.10−2.33), respectively. The risk of developing stroke was significantly higher for men (HR<sub>Quintile 5 vs. 1</sub> 2.06; 95% CI 1.07−3.98; <i>p</i> = 0.003), but not for women. A pro-inflammatory diet, as indicated by higher DII scores, was associated with increased risk of CVD and stroke among men.
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