Prevention is equivalent to causal treatment of cardiovascular disease. Nowadays, guidelines are elaborated on the basis of large-scale long-term intervention studies and structured meta-analyses. This review attempts a synopsis of guidelines of the American and German Heart Associations. For secondary prevention, smoking cessation, blood pressure treatment, dietary lipid management, aerobic activity, correct body weight, Mediterranean diet, treatment of diabetes to a HbA1c of 7%, ingestion of marine w-3 fatty acids (1 g / day), platelet inhibitors, lipid-lowering agents (statins), beta-blockers and ACE-inhibitors are established. In primary prevention pharmaceutical agents are not incorporated, but all non-pharmacological approaches are being recommended. The guidelines mentioned are based on unequivocal evidence, risk-benefit and cost-benefit ratios are good, nevertheless implementation remains a serious problem. Primary and secondary prevention are already giving way to risk-adapted prevention, based on an individual assessment of a person's cardiovascular risk.