Introduction e598 1.1. Methodology and Evidence Review e599 1.2. Organization of the Writing Committee e599 1.3. Document Review and Approval e599 1.4. Scope of the Guideline e599 1.5. Class of Recommendation and Level of Evidence e600 1.6. Abbreviations e601 2. Overarching Recommendations for ASCVD Prevention Efforts e601 2.1. Patient-Centered Approaches to Comprehensive ASCVD Prevention e601 2.2. Assessment of Cardiovascular Risk e602 3. Lifestyle Factors Affecting Cardiovascular Risk e605 3.1. Nutrition and Diet e605 3.2. Exercise and Physical Activity e607 4. Other Factors Affecting Cardiovascular Risk e609 4.1. Adults With Overweight and Obesity e609 4.2. Adults With Type 2 Diabetes Mellitus e610 4.3. Adults With High Blood Cholesterol e612 4.4. Adults With High Blood Pressure or Hypertension e616 4.5. Treatment of Tobacco Use e618 4.6. Aspirin Use e621 5. Cost and Value Considerations e622 6. Conclusion e623 Appendix 1: Search Criteria e636 Appendix 2: Author Relationships With Industry and Other Entities (Relevant) e641 Appendix 3: Reviewer Relationships With Industry and Other Entities (Comprehensive) e642 References e624 TOP 10 TAKE-HOME MESSAGES FOR THE PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE 1. The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life. 2. A team-based care approach is an effective strat- egy for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of health that affect individuals to inform treat- ment decisions. 3. Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardio- vascular disease (ASCVD) risk estimation and have a clinician patient risk discussion before starting on pharmacological therapy, such as antihyper- tensive therapy, a statin, or aspirin. 