Literature highlights the need for adjustment for diet quality when the effect of alcohol consumption on health is investigated. We sought to define—a-posterior—dietary patterns according to various drinking preferences as well as to evaluate their combined effect against 10-year cardio-metabolic incidence. During 2001–2002, 3042 CVD-free adults consented to participate in the ATTICA study; of them, 2583 completed the 10-year follow-up (85 % participation rate), but precise information about cardio-metabolic incidence was available in 2020 participants (overall retention rate 66 %). Intake per type of alcoholic beverage was assessed and “a posterior” dietary patterns were defined. Results showed that among participants not drinking alcoholic beverages, women adhering more to a healthier dietary pattern had 25 % lower CVD risk within the 10-year study follow-up, while men adhering more to an unhealthy dietary pattern had almost two times higher CVD risk (p-values < 0.05). Among beer drinkers, both men and women adhering more to a healthier dietary pattern were found to have at least 26 % lower risk of developing hypertension and at least 15 % lower risk of developing hypercholesterolemia, while men adhering more to a healthier dietary pattern were also found to have 29 % lower CVD risk (all p-values < 0.05). Similarly, among wine drinkers, women adhering more to a healthier dietary pattern were found to have a 16 % and 52 % lower risk of developing hypertension and diabetes mellitus, respectively, whereas men adhering more to a healthier dietary pattern had 22 % lower CVD risk (all p-values < 0.05). Finally, among spirit drinkers, higher adherence to an unhealthy dietary pattern in both genders had an aggravating effect on cardio-metabolic risk. It seems that the quality of dietary pattern stands out as a critical confounding factor in studies assessing the effect of alcohol consumption on cardio-metabolic risk. A Phytochemical-Rich Dietary Pattern is suggested, particularly among drinkers.