New biochemical and genetic markers will be required to be more successful in the prevention of coronary heart disease. Postprandial lipid metabolism has received considerable attention since it was shown that postprandial triglyceride-rich lipoproteins are independently involved in the development of atherosclerosis. Multiple genes and environmental factors work in concert to alter these lipid. In this paper, postprandial lipemia, genetic variation and cardiovascular risk will be reviewed.