Previous studies showed that the Mediterranean diet may decrease the incidence and the mortality of stroke and cardiovascular diseases. I performed a systematic review to explore the association between adherence to the Mediterranean diet and the risk of cardiovascular disease. PubMed database was searched up to December 2015. A total of 10 studies were extracted for analysis. This review found that high adherence to the \nMediterranean diet was associated with reduced risk of stroke (22%-52%) and cardiovascular disease (2%-23%). In addition, the total mortality was decreased by 6%-19% in the high adherence group. The results of these studies and three meta-analyses strongly suggested a causal benefit of the Mediterranean diet. If causal, the Mediterranean diet is useful for primary and secondary prevention of cardiovascular disease. More randomized controlled trials are needed to confirm these observations. Future RCTs are also warranted to evaluate the protective effects of different food components in the Mediterranean diet so as to enhance our understanding of the underlying mechanisms of the cardio-protective properties and to provide more specific dietary guidelines for individual food items.