The past 20 years has witnessed the development of technologies designed to measure changes in the expressed human genome, including the levels of RNA transcripts, proteins, and metabolites. Gene expression profiling, or the measurement of RNA transcripts, allows investigators to obtain a snapshot of a subject's current physiological state and may be used to assess disease likelihood. In this review, we provide an overview of recent work using peripheral blood gene expression to assess coronary artery disease (CAD) and discuss the best approaches for developing and validating tests utilizing such gene expression signatures.