<p>Vascular diseases develop over decades. Avoidable exposures, such as tobacco use and insufficient implementation of evidence-based prevention strategies contribute to the progression. For angiology, prevention and prophylaxis therefore means an integrated approach to structural prevention, primary prevention and secondary prevention. Structural prevention particularly addresses nicotine products, including e‑cigarettes/vapes and nutrition, such as reducing sugar in processed foods. Primary prevention includes risk-adapted early detection and risk reclassification, which do not rely on population-based screening but on clearly defined target groups with immediate therapeutic consequences. In the case of manifest atherosclerotic disease, secondary prevention aims to prevent subsequent events, such as progression of peripheral arterial occlusive disease (PAOD), myocardial infarction or stroke. Of particular relevance is the consistent implementation of supervised exercise training (SET) for intermittent claudication, as despite clear recommendations there is still a&#xa0;significant deficit in implementation on a&#xa0;broad scale. In Germany, the framework conditions for prevention and healthcare are basically in place (e.g., health check-ups, ultrasound screening for abdominal aortic aneurysm in men above the age of 65&#xa0;years) but risk-adapted vascular risk stratification, reliable reimbursement and cross-sectoral programs such as SET/vascular exercise are not yet sufficiently systematized. This article identifies best practices, redundancies, evidence gaps and concrete areas for improvement and formulates practice-oriented and health policy-relevant lines of development.</p>