No data exist on the associations of dietary tomato and lycopene consumption with total and cause-specific mortality. Using the National Health and Nutrition Examination Surveys 1999–2010, we evaluted the long-term impact of tomato and lycopene intake on total and cause-specific (CHD and cerebrovascular disease) mortality. We also assessed the changes in cardio-metabolic risk factors according to tomato and lycopene intake. Vital status to 31 December 2011 was ascertained. Cox proportional hazard regression models (followed by propensity score matching) were used to investigate the link between tomato and lycopene consumption total, CHD and cerebrovascular mortality. Among the 23 935 participants included (mean age = 47·6 years, 48·8 % men), 3403 deaths occurred during 76·4 months of follow-up. Tomato intake was inversely associated with total (risk ratio (RR) 0·86, 95 % CI 0·81, 0·92), CHD (RR 0·76, 95 % CI 0·70, 0·85) and cerebrovascular (RR 0·70, 95 % CI 0·62, 0·81) mortality. Similar inverse associations were found between lycopene consumption, total (RR 0·76, 95 % CI 0·72, 0·81), CHD (RR 0·73, 95 % CI 0·65, 0·83) and cerebrovascular (RR 0·71, 95 % CI 0·65, 0·78) mortality; these associations were independent of anthropometric, clinical and nutritional parameters. Age and obesity did not affect the association of tomato and lycopene consumption with total, CHD and cerebrovascular mortality. C-reactive protein significantly moderated the link between lycopene and tomato intake with total, CHD and cerebrovascular mortality. ANCOVA showed that participants with a higher tomato and lycopene consumption had a more cardio-protective profile compared with those with a lower intake. Our results highlighted the favourable effect of tomato and lycopene intake on total and cause-specific mortality as well as on cardio-metabolic risk factors. These findings should be taken into consideration for public health strategies.