Purpose of Review <p>Heart failure (HF) is a complex clinical syndrome that develops as the final common manifestation of diverse cardiovascular disorders along a variety of different pathophysiological pathways. The trajectory towards HF is set decades earlier by a combination of non-modifiable risk factors and a substantial number of principally modifiable risk factors. Conceptualizing HF prevention as a continuum — from primordial prevention to tertiary prevention — highlights how consistently these factors determine and drive the risk to develop HF. Early at-risk and pre-HF stages therefore represent the most appropriate window for effective prevention, yet they are still underrated and under-recognized in clinical practice.</p> Recent Findings <p>A broad array of modifiable risk factors, together with echocardiographic and laboratory markers, are involved in disease progression. Combining these domains may optimize risk stratification and enable more targeted prevention efforts.</p> Summary <p>The rapidly evolving heart failure pandemic, largely driven by the rising prevalence of conditions that are to a substantial extent attributable to modifiable risk factors, poses an enormous burden on health systems worldwide. In consequence, enhanced global awareness, comprehensive assessment and more effective control of modifiable risk factors are urgently needed to prevent HF. A multidimensional risk assessment approach could facilitate early identification and timely intervention to prevent progression to symptomatic HF.</p>