The current National Cholesterol Education Program Adult Treatment Panel III guidelines recommend specific target levels of LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) for determining cardiovascular disease (CVD) risk and evaluating the effectiveness of lipid-lowering therapies. While there is a growing consensus that levels of apolipoprotein (apo) B and the ratio of apo B/apo A-I are more accurate predictors of CVD risk, the question has been raised as to whether it is realistic to expect patients and health professionals to switch from cholesterol-based guidelines to apolipoprotein-based guidelines. Because it will take time before apolipoprotein terminology is recognized by the general public and recommended by the NCEP Adult Treatment panel to evaluate risk, it may be more efficacious to continue adhering to the already familiar and proven measurements of the LDL-C/HDL-C ratio. The following review provides evidence that the LDL-C/HDL-C ratio continues to be a valuable and standard tool to evaluate CVD risk in all populations.