In this review, data are reviewed concerning various metabolic risk factors that have been associated with coronary heart disease, drawing upon the experience of observational studies and clinical trials. Topics include lipids, glycemia, secular trends, hematologic factors, homocysteine, estrogen replacement, and familial and genetic factors. Using combinations of these types of factors in multivariate risk profiles is discussed, along with the opportunity to incorporate some of these factors into the prediction of coronary heart disease in the future.