Coronary heart disease is the leading cause of death worldwide, and has traditionally been assessed through a patient’s cardiovascular risk profile that is comprised of a combination of genetic, social, physiologic, and environmental factors. A growing discordance is being recognized in the ability of current risk estimation tools to predict outcomes versus that of actual measured outcomes. Exciting new improvements in technology have made noninvasive imaging modalities of the heart—in particular, coronary artery calcium score (CACS) and coronary computed tomography (CT) angiography—an increasingly important component in the diagnosis of ischemic heart disease. The CACS has been found to be a marker of vascular injury that correlates closely with overall atherosclerotic burden, whereas coronary CT angiography permits detection of noncalcified plaque coronary artery stenosis severity. A growing body of literature has developed detailing the valuable prognostic utility of these tests in the management of patients and how they may 1 day be used to complement current risk prediction models.