Cardiovascular disease remains the leading cause of mortality in the Westernised world. Lifestyle changes and drug therapy can reduce cardiovascular risk. Many interventions such as lipid-lowering therapy reduce relative risk to the same extent irrespective of baseline risk, but the absolute benefit is still highest in those with the highest absolute risk. Cardiovascular risk assessment is a tool to determine absolute cardiovascular risk in asymptomatic patients and to select those most likely to benefit from intervention. Conventional risk assessment (Framingham) requires age, gender, blood pressure, smoking status, total cholesterol and high-density lipoprotein cholesterol (HDLC) to determine risk. This is usually expressed as the 10-year risk of coronary heart disease. The accuracy and predictive ability of conventional risk assessment have limitations. Many biomarkers, genetic tests and vascular imaging procedures correlate statistically with vascular risk. Adding these tests to conventional risk assessment (expanded risk assessment) may therefore improve our ability to predict risk. It has, however, been difficult to conclusively demonstrate that expanded risk assessment outperforms conventional risk assessment. Many tests and procedures require further validation before they become part of routine clinical practice. Additional testing may be useful in patients with intermediate risk or where risk is difficult to determine for other reasons.