Non-invasive diagnostic techniques such as electron beam computed tomography and multislice spiral computed tomography are able to detect and quantify coronary calcifications. Several clinical studies have shown how the amount of coronary calcifications correlates to the coronary plaque burden. The detection of coronary calcium therefore provides a unique opportunity to identify and quantify coronary atherosclerosis in a subclinical stage. Measures of subclinical atherosclerosis may also help in recognizing factors related to atherosclerosis in asymptomatic populations. In addition, a significant proportion of subjects who develop premature clinical disease are not identified as being at high risk by current strategies. A scan negative for coronary calcium has a high negative predictive value indicating the absence of stenotic coronary artery disease. The aim of this review was to describe the potentials of coronary calcium detection and to summarize its clinical relevance.