Clinical practice guidelines exist in many different forms and in a wide spectrum of therapeutic areas; some recommendations are directed at specialists and others at a primary care audience, some focus on prevention and others on treatment of disease. In all of their various guises, guidelines represent an attempt to bridge the gap between the generation and the application of scientific evidence. Successful guideline implementation should improve quality of care by expediting the utilization of effective advances in everyday practice. Guidelines for the prevention of cardiovascular disease (CVD) are particularly numerous. More so than in most therapeutic areas, scientific evidence continues to accumulate rapidly demonstrating that lifestyle interventions and the use of pharmacological therapies in patients with CVD and other selected high-risk individuals can reduce cardiovascular morbidity and mortality. However, despite widespread dissemination of comprehensive guidelines over several years, CVD remains the primary cause of mortality worldwide. It seems apparent, therefore, that there is a failure to put into action what is known about prevention. In 2003, a small group of key opinion leaders, with previous involvement in the development and / or implementation of CVD and coronary heart disease guidelines, held a series of workshops focused on current and future trends of clinical guidelines in the management of atherosclerosis. The objectives were to stimulate dialogue around the convergence / divergence of guidelines on an international basis; to discuss the practicalities of guideline implementation and to identify future trends in the evolution of guidelines. Here, we summarize the key discussions of the workshops.