Patients with cardiovascular risk factors are largely undertreated, for many reasons. Vulnerable individuals may not be aware of the risks they are facing or an individual's risk of cardiovascular disease may be underestimated, particularly among those at high risk. Furthermore, in individuals identified as being at high total cardiovascular risk, the full spectrum of therapeutic options may not be implemented or patients may not adhere to the treatment prescribed. We address these critical issues by summarizing the existing guidelines: our ultimate goal is to encourage the optimal management of individuals at high total cardiovascular risk according to evidence-based medicine, with the expectation that this will improve outcomes.