Cardiovascular disease (CVD) is a leading global cause of mortality and morbidity. Risk assessment of asymptomatic individuals plays an important role in the primary prevention of CVD and its complications by guiding management decisions, in particular the decision to use statins or antiplatelet agents, as well as more controversially, the target level for risk factors such as hypertension and cholesterol. Timely and regular risk assessments also identify the development of physiological disturbances such as pre-hypertension, pre-diabetes, dyslipidaemias, clinical obesity and metabolic syndrome, which can be asymptomatic in the early stages, but may lead to increased risk for many ageing-related degenerative diseases, including CVD. These physiological mal-adaptations are remarkably responsive to behavioural lifestyle interventions at an early stage, and may be stabilised or even reversed without medications. This article describes the why and how of assessing CVD risk and a suggested framework for management, including the appropriate use of behavioural lifestyle interventions as first-line treatment. It also describes the various risk scores available, their differences and limitations and how to best use them in clinical practice. More research is required regarding the use of non-traditional and emerging markers of CVD risk such as carotid intima-media thickness, coronary artery calcium scoring, hsCRP, ankle brachial index, Apo-B, albuminuria, and how they may be incorporated into existing risk models.