Lipid lowering therapies and aggressive life style modifications can induce regression of coronary artery disease as demonstrated by several angiographic studies. Such regression has also been associated with greatly reduced cardiovascular event rates. However, coronary angiography is invasive and expensive and other non-invasive diagnostic approaches would be preferable. Electron beam computed tomography imaging is used to detect coronary artery calcification, it is non-invasive and considerably less expensive than angiography. This tool provides an opportunity to serially monitor the effectiveness of medical therapy for coronary artery disease via the follow-up of a surrogate marker of disease such as vascular calcification. We review the current status of the literature on the use of electron beam computed tomography as a tool to follow progression of disease.