BACKGROUND: Current guidelines fail to adequately identify and prevent cardiovascular prevention in young adults, even when a family history of cardiovascular disease (CVD) is known. PURPOSE: We aim to assess the feasibility and acceptability of a routine family-based cardiovascular risk assessment in first-degree relatives of individuals with premature coronary artery disease (CAD). METHODS: Patients with premature CAD were prospectively asked about pre-existing CVD cases and previous cardiovascular check-ups among their first-degree relatives. They were then encouraged to invite their healthy and naïve to cardiology follow-up relatives to contact the cardiology department for consultation. The primary outcome was the eligibility of relatives for initial cardiovascular evaluation, defined by the absence of previously known CVD or active primary prevention. RESULT: The cardiovascular status of first-degree relatives was evaluated in the families of 137 probands with premature CAD. Of the 626 identified first-degree relatives, 153 (24.4%) had known CVD, primarily CAD (19.6%). Among 352 siblings and adult-children, 48 (13.7%) were already diagnosed with CVD, 68 (19.3%) were being treated or followed for primary prevention, and 226 (64.2%) were eligible for initial cardiovascular check-up. Within 12 months, 11.1% of eligible relatives initiate screening. CONCLUSION: This pilot study revealed 1/a significant familial burden of CVD, 2/opportunities for proactive primary prevention in two out of three of young relatives, and 3/challenges in engaging non-symptomatic adults in a cardiovascular screening based on family history.