It has long been known that family history is a potent risk factor for CAD. Early in my career it was well recognized that the disease clustered in some families which lacked all the traditional risk factors. Specific genetic disorders, such as familial hypercholesterolemia, were identified in only a small fraction. We knew the other patients must have had genetic disorders which at that time had not yet been well characterized or had not been discovered. The field has seen remarkable advances since then, with many applications ready for prime time in clinical practice. This update by H. Robert Superko and colleagues is a must read. Dr. Superko is a course director and regular speaker at the Tutorials in the Tetons Update in Cardiovascular Diseases.