Cardiovascular medicine has a sound evidence base upon which health professionals can base their interventions to modify risk among the British public. For primary prevention of cardiovascular disease, however, while there is considerable evidence on what to do, data are limited on how the evidence should be implemented in practice. The challenge will be to learn by experience which interventions directed at reducing blood pressure and lipids levels work best in different settings. There is a need to structure care to identify individuals who are at risk. Current targets are explicit and achievable for both hypertension and lipids. Effective treatment is likely to require multiple drug treatment.