Furthermore, longstanding dietary patterns that focus on low intake of carbohydrates and a high intake of animal fat and protein are associated with increased cardiac and noncardiac mortal- low- carbohydrate diets were associated with a 31% higher risk of all-cause death, with increased cardiac mortality rate. Population data from the ARIC (Atherosclerosis Risk in Communities) study indicated an 18% increase in mortality rate with CLINICAL STATEMENTS AND GUIDELINES low-carbohydrate diets using animal-derived protein and fat sources (eg, lamb, beef, pork, but plant sources (eg, vegetables, nuts, peanut butter, whole-grain breads) were associated with lower mortality rate. In addition, the ARIC investigators noted a 23% increase in mortality rate associated with high-carbohydrate diets, with the optimal carbohydrate intake observed to be 50% to 55%. 5. Intake of trans fat has been shown to be harm- ful and increase risk of ASCVD. Trans fat was associated with higher all-cause mortality rate in the REGARDS US healthcare professionals cohort Additionally, regulations to curb use of trans fat in the food industry have been associated with a decrease in stroke and Trans fats have adverse effects on lipid and lipoproteins and promote endothelial dys- function, insulin resistance, inflammation, and Since partially hydrogenated oils are optional food additives, their elimination has been a public health priority.S3.1-27 3.2. Exercise and Physical Activity Recommendations for Exercise and Physical Activity Referenced studies that support recommendations are summarized in Online Data Supplements 6 and 7. 