Molecular lipid species such as ceramides have been linked with processes involved in atherosclerotic development, such as lipoprotein uptake, inflammation, and apoptosis. Laaksonen et al. sought to determine the role of ceramides and their distinct ratios as predictors of cardiovascular (CV) death in patients with stable coronary artery disease (CAD) or acute coronary syndrome (ACS). Ceramides were significantly associated with CV death in all patients, independent of other lipid markers and C-reactive protein level, particularly when ratios were used. Furthermore, ceramide also predicted CV death in statin-treated patients, and is, therefore, an indicator of residual risk. “Ceramide testing is entering the clinic this year,” explain the investigators, “and only this real-life evaluation will allow for a better judgement of the ceramide utility and will establish them as a new armament in the clinical diagnostic tool-kit.”