Cardiovascular disease due to atherosclerosis is the foremost cause of premature mortality and of disability-adjusted life years in Europe. Risk stratification management includes variety of clinical, laboratory and special diagnostic methods with different relevance. However, because global risk scores tend to underestimate risk in most persons, atherosclerosis imaging has been introduced for the refinement of stratification. Cardiac techniques including computed tomography (CT) have evolved rapidly for the study of cardiovascular structure and function. Multidetector CT is an additional relevant potential tool for assessment of coronary artery disease in selected patients and scientific data will be continuing to expand into clinical practice. Our findings showed that utility may be helpful also in non-diabetic patients with arterial hypertension or renal insufficiency and in elderly with degenerative aortic stenosis.