In the context of the beneficial effects of statins, irrespective of the low-density lipoprotein cholesterol level (LDL-C) in the Heart Protection Study and the relatively poor event reduction (24%-37%) in the LDL-C reduction trials, electron beam tomography plaque imaging has provided the necessary data to support a reorientation of traditional treatment paradigms. The prognostic superiority of calcified plaque quantitation to conventional risk factor assessment and the poor correlation between pretreatment standard lipid values and amount of plaque in individual patients, as well as between post treatment lipid changes and changes in calcified plaque burden, suggest the following: (1) significant calcified plaque shifts the asymptomatic patient from primary to secondary prevention status; (2) "abnormal" lipid values in individual patients are best defined by the level at which atherosclerosis develops; (3) non LDL-C disorders contribute to CAD and should be identified and treated; (4) plaque burden, rather than plasma lipid values, should be the target of therapy; and (5) adequacy of therapy is best evaluated with serial plaque imaging. Other treatment applications of plaque imaging include triage of patients for stress testing and evaluation of stress test results.