Recent advances in lipidology and metabolic aspects of atherosclerosis allow detailed coronary artery disease (CAD) risk assessment that is of clinical relevance. Genetic dyslipidemias can be identified in over 75% of CAD patients and include the atherosclerosis susceptibility trait (low density lipoprotein [LDL] pattern B), hyperapobetalipoproteinemia, lipoprotein (a), apo E isoforms, and lipoprotein susceptibility to oxidative damage. The inherited amino acid disorder homocysteinemia is present in approximately 20% of CAD patients and is easily treated. Recent studies have highlighted significant differences in response to diet and drug therapy that can be predicted based on the presence or absence of these traits.