Clinical practice guidelines attempt to bridge the gap between the generation of scientific evidence and its application. For cardiovascular risk reduction, the implementation of knowledge into practice, both with respect to lifestyle change and pharmacological treatment, has been shown to be poor. There are several reasons for this ‘guidelines gap’, with physician factors including insufficient time and underestimation of a patient’s cardiovascular risk and patient factors including lack of adherence to lifestyle modification and lack of awareness about cardiovascular risk. Survey data indicate that physicians believe that they are implementing guidelines, but the majority of patients remains undertreated. There is a need for better physician and patient education and also for simplified guidelines to encourage their use by physicians. Cardiologists should work with primary care physicians to adapt national guidelines to ensure local acceptance.