Traditional lipid measures are the cornerstone of risk assessment and treatment goals in cardiovascular prevention. Whereas the association between total, LDL-, HDL-cholesterol and cardiovascular disease risk has been generally acknowledged, the rather poor capacity to distinguish between patients who will and those who will not develop cardiovascular disease has prompted the search for further refinement of these traditional measures. A thorough understanding of lipid metabolism is mandatory to understand recent developments in this area. After a brief overview of lipid metabolism we will discuss the epidemiological data of total, LDL- and HDL-cholesterol and focus on recent advances in measurements of these lipoproteins. In addition we will discuss the role of triglycerides and the apolipoprotein B–A-I ratio on the incidence of cardiovascular disease.