Collaborative decisions are more likely to address potential barriers to treatment options, compared with treatment and guidance offered without patient input.S2.1-15 S2.1-18 3. Socioeconomic inequalities are strong determinants of CVD risk internationally.S2.1-21,S2.1-24 Therefore, the clinician should tailor advice to a patient s socioeco- nomic and educational status, as well as cultural, work, and home environments.S2.1-23 The Centers for Medicare & Medicaid Services has developed a CLINICAL STATEMENTS AND GUIDELINES screening tool to assess 5 domains of non health- related measures that affect health outcomes: housing instability, food insecurity, transportation difficulties, utility assistance needs, and interper- ASCVD prevention could ben- efit from such screening. ASCVD risk begins early in life, with heightened susceptibility tied to low Examples of upstream social determinants of health that affect treatment adherence and ASCVD health outcomes include comorbid mental illness, lack of health literacy, exposure to adversity (eg, home/community vio- lence, trauma exposures, safety concerns), finan- cial strain, inadequate housing conditions, lack of food security (ie, access to affordable and nutritious food), and inadequate social support.S2.1-30 Systems of care should evaluate social determinants of health that affect care delivery for the primary pre- vention of ASCVD (eg, transportation barriers, the availability of health services). Important considerations related to socioeco- nomic disadvantage are not captured by existing CVD risk equations.S2.1-31 Addressing unmet social needs improves management of BP and lipids,S2.1-32 which highlights the importance of dietary coun- seling and encouraging physical activity.S2.1-19 More time may be required to address ASCVD preven- tion with adults of low health literacy or disadvan- taged educational backgrounds. Differential cardiovascular outcomes persist by important sociodemographic characteristics that include but are not limited to age, sex, and race/ Failure to address the impact of social determinants of health impedes efficacy of proven prevention recommendations. 