Further research and methodological advances are needed to comprehen- sively characterize the full spectrum of benefits pro- duced by the prevention approach, thereby rendering cost-effectiveness assessments more consequential to clinical practice. Most ASCVD events are avoidable through primordial prevention (ie, the prevention of risk factor develop- ment) and control of traditional cardiovascular risk fac- tors. Tobacco avoidance is critically important for AS- CVD prevention, and all adults should strive to engage in regular brisk physical activity most days of the week and adhere to a healthy dietary pattern to help lower future ASCVD risk. A diet high in fruits, vegetables, and whole grains is best. Fish, legumes, and poultry are the preferred sources of protein. Minimizing the consumption of trans fats, added sugars (including sugar-sweetened beverages), red meats, sodium, and saturated fats is also important. Clinicians should work in partnership with patients to assess their readiness for sustained lifestyle improvements, identify poten- tial barriers to change, and encourage them to try to achieve measurable goals and continue to monitor Finally, social determinants of ASCVD risk and their impact on the patient s ability to pre- vent or treat risk factors must be taken into account. Clinicians need to consider patients health literacy and education levels and assess patients motivation to im- prove their lifestyle habits. The goal of the clinician is to match the intensity of preventive efforts with an individual s absolute risk of a future ASCVD event and with the individual s willing- ness and capacity to implement preventive strategies. Risk estimation is imperfect and based on group aver- ages that are then applied to individual patients. The clinician must balance an understanding of a patient s estimated ASCVD risk with potential benefits and ad- verse risk from pharmacological therapy in the context of a risk discussion. 