We recently featured Chinese dietary patterns that were associated with obesity, hyperglycemia, hypertension, and metabolic syndrome. In this study, we examined the association of those dietary patterns and risk of stroke among 26,276 Chinese adults aged ≥45 y by using data from the 2002 China National Nutrition and Health Survey and explored whether those associations were mediated by obesity, hypertension, hyperglycemia, and other cardiovascular risk factors. The traditional southern Chinese dietary pattern, characterized by high intakes of rice and vegetables and moderate intakes in animal foods, was related to the lowest prevalence of stroke. Compared to the traditional southern dietary pattern, the traditional northern Chinese dietary pattern, characterized by high intakes of refined cereal products, potatoes, and salted vegetables, was associated with an elevated risk of stroke [OR = 1.96 (95% CI = 1.48-2.60); P < 0.0001]. Adjustment for conventional cardiovascular risk factors did not appreciably change the association [multivariate adjusted OR = 1.59 (95%CI = 1.16-2.17); P = 0.004]. The Western dietary pattern characterized by high consumption of beef, fruit, eggs, poultry, and seafood is also associated with an elevated risk of stroke [OR = 2.36 (95%CI = 1.82-3.06); P < 0.0001], but the associations became nonsignificant after adjustment for obesity, hypertension, hyperglycemia, and dyslipidemia. In conclusion, we found that the traditional southern dietary pattern was related to low prevalence of stroke and the traditional northern dietary pattern was associated with an increased stroke risk. The Western dietary patterns also association with high risk of stroke, which was largely mediated by obesity, hypertension, hyperglycemia, and dyslipidemia.