Individuals with genetic predisposition to atherosclerosis have an increased risk for developing coronary artery disease (CAD), especially at young ages. They may derive the greatest benefit from traditional preventive strategies and strategies targeting novel,emerging risk factors. Because CAD is a complex, multifactorial disorder, global risk assessment has been recognized as an effective approach in preventing CAD and its manifestations. The systematic collection and interpretation of family history information is currently the most appropriate screening approach to identify individuals with genetic susceptibility to CAD. Much of the familial aggregation of CAD might be explained by familial aggregation of established risk factors and emerging CAD risk factors. Tests to assess genetic risk for CAD are primarily biochemical analyses that measure the different pathways involved in development and progression of disease. Some of these can guide and explain responses to treatment.