Coronary artery disease (CAD) is currently one major cause of death in the world [1, 2]. CAD is mainly caused by atherosclerosis, which is considered as a chronic inflammation in response to cholesterol accumulation in the arterial wall [3]. Therefore, biomarkers that can predict the presence for early atherosclerotic process and CAD are desirable. Lipidomics is playing vital role in development of atherosclerosis and in cardiovascular disease. Various inflammatory markers and lipid biomarkers are playing role in diagnosis of CAD. Inflammatory biomarkers such as CRP, cytokines [interleukin (IL)-1, IL-6, IL-8, monocyte chemoattractant protein-1 (MCP-1)], soluble CD40 ligand, serum amyloid A (SAA), selectins (E-selectin, P-selectin), myeloperoxidase (MPO), matrix metalloproteinases (MMPs), cellular adhesion molecules [intercellular adhesion molecule 1 (ICAM-1), vascular adhesion molecule 1 (VCAM-1)], placental growth factor (PlGF) and A2 phospholipases may have a potential role for the prediction of risk for developing CAD and may correlate with severity of CAD..Dyslipidemia is major cause of Cardiovascular disease. Ceramide a lipid biomarker is playing a emerging role in diagnosis of CAD, In this review we tried to focus role of Ceramide in diagnosis of CAD and to further risk stratify patients who may otherwise not receive treatment but would remain at high risk for a serious cardiac event. These are patients who could benefit from more intensive treatment, for example: a higher-dose statin, a nutritionist consult or formal exercise therapy. Cardiologists at Mayo Clinic are already routinely checking Ceramides using the new test.