Objective: Mortality rates from ischemic heart disease vary among ethnic groups. Dietary intake of fruits and vegetables has been associated with a lower risk of ischemic heart disease, but ethnic-specific data are limited. Design: Prospective cohort study. Setting: Hawaii and Los Angeles County, between 1993 and 1996. Participants: These analyses included 164,617 adults age 45 to 75, representing five ethnic groups who were enrolled in the Multiethnic Cohort Study. Dietary data were collected at baseline using a validated food frequency questionnaire and fatal ischemic heart disease cases were identified up to December 31, 2001. Associations between fruit and vegetable consumption and fatal ischemic heart disease were examined using multivariate Cox proportional hazard models. Results: The associations between fruit and vegetable intake and fatal ischemic heart disease were similar among the five ethnic groups. When data for the ethnic groups were combined, higher vegetable intake was associated with a protective effect against ischemic heart disease in men with all intake levels above 3.4 servings per day (over 6.6 servings per day: hazard ratio, 0.73; 95% confidence interval, 0.58–0.92). Inconsistent results were observed for women, where the protective association was observed only at mid-level vegetable intake levels, but not among women with the highest level of vegetable intake. There was no evidence of an association for fruit intake. Conclusions: Associations between fruit and vegetable intake and fatal IHD do not appear to vary among ethnic groups. Additional research is needed to clarify associations for fruit versus vegetable intake and impact on cardiovascular outcomes.