Background: Few studies have investigated the impact of dietary patterns that reflect existing eating habits on the risk of all-cause or cause-specific mortality. Objective: To prospectively examine the relation between major dietary patterns and the risk of all-cause and cause-specific mortality among women of the Nurses’ Health Study. Methods: The participants included 72,113 women aged 35 to 55 years without a history of cancer, myocardial infarction, angina, coronary artery surgery, stroke, or diabetes at baseline. Dietary patterns were derived by factor analysis using information from five repeated, validated food frequency questionnaires that were administrated at baseline and every 2 to 4 years during the follow-up period (1984–2002). Cox proportional hazards regression was used to adjust for covariates including age, cigarette smoking, physical activity, body mass index, and further suspected risk factors. Results: Two major dietary patterns were identified. High prudent pattern scores represented high intakes of vegetables, fruit, legumes, fish, poultry, and whole grains, whereas high western pattern scores represented high intakes of red meat, processed meat, refined grains, french fries, condiments, and sweets and desserts. During 18 years of follow-up (633,516 person-years), we ascertained 6,011 deaths, including 3,139 cancer deaths and 1,154 cardiovascular deaths. After adjustment for potential confounders, the prudent diet was inversely associated with all-cause mortality (relative risk [RR] = 0.83 for highest versus lowest quintile, 95% confidence interval [CI] = 0.76 – 0.90, p for trend < 0.0001) and cardiovascular mortality (RR = 0.72, 95% CI = 0.60 – 0.87, p for trend = 0.0007), but not with cancer mortality (RR = 0.99, 95% CI = 0.88 –1.11, p for trend = 0.87). The western pattern was directly associated with all-cause mortality (RR = 1.21, 95% CI = 1.11–1.32, p for trend < 0.0001), cardiovascular mortality (RR = 1.22, 95% CI = 1.00 –1.48, p for trend = 0.01), and cancer mortality (RR = 1.15, 95% CI = 1.02–1.29, p for trend = 0.004). Conclusions: These data provide evidence that a high prudent pattern score and a low western pattern score may reduce the risk of total and cause-specific mortality.