Despite overwhelming evidence supporting the benefits of cardiovascular protective therapies and risk reduction in patients with or at risk for coronary heart disease, these strategies remain underutilized in clinical practice. Preventive cardiology guidelines from the American Heart Association, the American College of Cardiology, and others focus on primary and secondary prevention with the use of medications, risk factor control measures, and lifestyle modification. Still, a “treatment gap” remains between the guidelines and their actualization. A systematic approach including both inpatient and outpatient measures is necessary. This article discusses the current guidelines and addresses ways to increase implementation of evidence-based, guideline-recommended treatment by healthcare providers caring for at-risk patients.