Observational and clinical trial data provide a substantial information base upon which current and future recommendations can be made for preventive therapy of coronary artery disease. Based on these data, it is possible to stratify potential therapies into four levels of anticipated effectiveness: 1) Interventions proven to alter risk are those directed at diet, LDL cholesterol, hypertension, smoking and platelet adhesion. 2) Interventions that are likely to alter risk are those directed at diabetes; physical inactivity; HDL cholesterol; triglycerides and small, dense LDL; obesity; and estrogen replacement. 3) Interventions that might alter risk are those directed at homocysteine, Lp(a) and oxidative stress. 4) Risk factors that cannot be modified include age, gender and family history. As the contribution of genetically regulated risk factors are further defined, it seems likely that prevention of coronary artery disease and its complications will become progressively individualized and increasingly effective.