Prevention of atherosclerotic cardiovascular disease (ASCVD) has traditionally been focused on primary prevention, namely modification of established risk factors, in adulthood. However, the association of risk factors with subclinical and clinical ASCVD is continuous and the risk starts to increase even with slightly elevated risk factor levels and cumulative exposure to risk factors has a key role in the disease process. Based on longitudinal data, the prevention of ASCVD is best achieved by maintaining optimal risk factor levels from childhood through middle age. Furthermore, even when optimal risk factor status is lost, it can be regained by improving health behaviors. Thus, avoiding the development of risk factors in the first place (primordial prevention) has gained more attention in the last decades. Accordingly, in 2010 the American Heart Association published the first formal definition of ideal cardiovascular health. The statement included seven components across two major areas (health behaviors and health factors), that was subsequently called Life’s Simple 7 and recently revised to include an additional component to Life’s Essential 8 (healthy diet, participation in physical activity, avoidance of nicotine, healthy sleep, healthy weight, and healthy levels of blood lipids, blood glucose, and blood pressure). Through preventive efforts starting already in childhood focusing on ideal cardiovascular health, it should be possible to maintain low-risk status into adulthood resulting in a very low lifetime risk for ASCVD.