Although RCTs focused on hard endpoints are limited, multiple observational studies have focused on the association of CVD mortality with dietary patterns specifically, sugar, low-calorie sweeteners, high-carbo- hydrate diets, low-carbohydrate diets, refined grains, trans fat, saturated fat, sodium, red meat, and pro- cessed red meat (eg, bacon, salami, ham, hot dogs, Processed meats are any meat pre- served by smoking, curing, or salting, or additional Recommendation-Specific Supportive Text 1. Plant-based and Mediterranean diets, along with increased fruit, nut, vegetable, legume, and lean vegetable or animal protein (preferably fish) con- sumption, with the inherent soluble and insoluble CLINICAL STATEMENTS AND GUIDELINES vegetable fiber, have consistently been associated with lower risk of all-cause mortality than control or standard dietsS3.1-1 S3.1-10,S3.1-29,S3.1-30 in observa- tional studies. The PREDIMED (Prevenci n con Dieta Mediterr nea) trial randomized participants to a Mediterranean diet supplemented with either extra-virgin olive oil or nuts and demonstrated 30% and 28% reductions, respectively, in the combined endpoint (MI, stroke, or cardiovascular mortality), but the improved outcome was driven largely by the reduction in stroke, with no signifi- cant improvement over the control diet for mor- tality or MI.S3.1-1 When the PREDIMED cohort was reanalyzed post hoc for the provegetarian food pattern (more vegetable consumption versus ani- mal, egg, fish, dairy, or meat product consump- tion), a significant mortality rate reduction (41%) was noted in the 2 quintiles with the highest A comparison of plant and animal protein from the Adventist Health Study-2 similarly indicated that using meat for protein was associated with a 61% increase in mortality rate, whereas replacing meat with nuts and seeds was associated with a 40% reduction in mortality rate. Similarly, the graded risk published by Song et al. 