As the second Roundtable in the three part PRIME Heart Initiative series, this meeting advances the conversation from earlier risk detection to action, focusing on when clinicians should act and how evidence-based prevention interventions can be sequenced for lifetime benefit in routine care. Building on the premise that early cardiovascular, kidney, and metabolic risk signals should prompt timely, stage appropriate action, the discussion will focus on practical decision points that can help clinicians intervene earlier to reduce lifetime ASCVD risk.

The Roundtable sessions will first examine gaps between guideline-based recommendations and real world clinical decision making, including factors that contribute to delayed action and challenges in patient engagement. Discussions will highlight common barriers encountered in brief visits, such as uncertainty in early or borderline-risk scenarios, competing priorities across multiple risk factors, and patient hesitancy or low perceived risk.

The Roundtable will then shift to defining solutions, emphasizing clinic-ready approaches that can be implemented within the four walls of clinic practice. Discussions will focus on clarifying the key requirements for helping clinicians initiate, prioritize, and adapt interventions over time, make lifestyle assessment and counseling feasible and actionable in a time-limited encounter, and strengthen shared decision-making to improve understanding, acceptance, and longterm adherence.

Ultimately, the Roundtable aims to generate actionable insights that help clarify who to treat, when to act, and how to intervene, supporting a more proactive, risk-guided approach to ASCVD primary prevention.