(2019) found that a Mediterranean diet reduced composite CV events, stroke, incidence of Type 2 DM, MI, and CV and all-cause mortality and improved the management of dyslipidemia.[129] Wu et al. (2015) conducted a meta-analysis of 18 studies that showed a significant dose-related response between dietary fiber intake and the risk of CHD and concluded that a higher intake of fiber, as in the Mediterranean diet, led to lower risk of CHD morbidity and mortality.[130] The Mediterranean diet includes a high unsaturated fat/saturated fat ratio, a substantial increase in fiber from plant-based foods (fruits, vegetables, nuts, legumes, and grains), an increased intake of fish, moderate intake of low-fat dairy products, and a low-to-moderate red wine intake for those who drink alcohol. Moreover, evidence suggests lipid outcomes were improved when a registered dietitian provided medical nutrition therapy for the management of dyslipidemia.[131] As this is a Reviewed, New-replaced recommendation, the Work Group systematically reviewed evidence related to this recommendation.[128,129] The Work Group s confidence in the quality of the evidence was low. With respect to diet, patient values and preferences vary largely. Given the lack of risks and harm related to this diet and the evidence showing improved CV outcomes, the Work Group decided upon a Weak for recommendation. Well-controlled RCTs are needed to evaluate the effectiveness of replacing saturated fat with unsaturated fats to determine the effect on CVD mortality and morbidity. Recommendation 26. For primary and secondary prevention of cardiovascular disease, we suggest regular aerobic physical activity of any intensity and duration. (Weak for | Reviewed, New-added) Discussion Although the benefits of regular physical activity involve many health domains, its effects on CV risk reduction are commonly cited by clinicians when advocating for lifestyle change to their patients. 