Atherosclerotic coronary heart disease (CHD) is a major health problem worldwide. Epidemiological studies have identified the role of several modifiable and non-modifiable risk factors in the pathogenesis of CHD. Aggressive risk modification has led to a significant improvement in the morbidity and mortality from CHD. However, there is a growing need to identify better modalities of risk prediction in CHD. Many of these newer risk markers, currently under evaluation, are based on the newer concept that atherosclerosis is more than merely a problem of lipid imbalance. There has been a recent shift in the paradigm towards inflammation and oxidative stress as the key drivers in the pathophysiology of atherosclerosis and its complications. Further understanding of this complex interplay of lipid and inflammatory factors is likely to pave way to a better understanding of this disease and its myriad complications.