Contrary to major national and international forecasts, life expectancy (LE) in the UK has not reached a plateau but has increased to 81y in 2020 (1) . However, at a ratio of healthy ageing life expectancy to LE at 0.8 (2) , the marked demographic shift has been accompanied by a higher prevalence of chronic diet-related non-communicative diseases (3) , including CVD and dementia (4) . Although substantial evidence from Mediterranean countries has verified the protective role of a traditional Mediterranean Diet (MedDiet) against CVD and age-related cognitive decline, it remains unclear if similar benefits occur in non-Mediterranean populations (5) . This study investigated associations between MedDiet adherence and memory performance in older UK-based adults at higher CVD risk.A secondary cross-sectional analysis of baseline data from 91 adults aged 54-74y at recruitment in the MedEx-UK study (6) was performed. MedDiet adherence was defined by the 14-item Mediterranean Diet Adherence Screener (MEDAS) questionnaire, and participants were dichotomised into higher and lower adherence groups at the sample-specific median MEDAS score. Participant characteristics between MedDiet adherence groups were compared using Chi-squared tests for categorical variables, and either independent sample t-tests or Mann-Whitney U tests for continuous variables, with statistical significance set at 0.05. Memory performance was evaluated using the Rey Auditory-Visual Learning Test (RAVLT) and the visual and verbal paired associates test. Using the MEDAS score both as a continuous and a categorical variable, linear alongside logistic regression models were implemented to examine associations between MedDiet adherence and episodic memory performance.The study sample was predominantly females (79.1%), Caucasian (98.9%) and mean ± SD participant age was 67.1 ± 4.6y. There were no significant differences between higher (MEDAS scores 6-12) vs. lower (MEDAS scores 0-5) MedDiet adherence groups for age, gender, BMI, smoking status, deprivation index, blood pressure, HDL cholesterol, medication use, the multicomponent cardiovascular QRISK2 score, and physical activity (all P > 0.05). In multivariate analyses iteratively adjusted for the same variables, there were no significant associations between MedDiet adherence and most episodic memory test outcomes (P > 0.05). Participants with lower MedDiet adherence were at increased odds of poorer performance in the immediate recall of the RAVLT (fully adjusted model, OR: 2.49; 95% CI: 1.03, 6.01; P = 0.043). However, this association was no longer statistically significant after using the Bonferroni-adjusted threshold for multiple comparisons (α = 0.01). In conclusion, there was no evidence of associations between MedDiet adherence and episodic memory in this cohort of UK-based adults at higher CVD risk. Larger prospective cohort studies and long-term RCTs, ideally targeting middle-aged individuals in prodromal dementia stages, are warranted to clarify associations with episodic memory, and other cognit...