While imaging of coronary artery calcium (CAC) and carotid intima media thickness (CIMT) is being increasingly used for cardiac risk stratification, residual risk after treatment has relied on changes in lipid values. Unfortunately, there is no clear relationship between post-treatment lipids and event reduction, as evidenced by the persistently high event rates despite significant lipid modification. A new approach, combining changes in subclinical atherosclerosis with inflammatory and endothelial function parameters of disease activity, may offer a better alternative. Imaging technologies include CAC, CIMT, MRI, molecular imaging, and coronary CT angiography. High-sensitivity C-reactive protein and lipoprotein-associated phospholipase A2 are the most commonly used inflammatory markers. Endothelial function techniques include venous occlusion plethysmography, ultrasound flow-mediated dilation, pulse wave and contour analysis, peripheral arterial tonometry, and digital thermal monitoring. This article presents the various modalities and combinations of imaging and activity/endothelial function, as well as clinical recommendations and testing intervals.