Coronary heart disease (CHD) is the number one cause of morbidity and mortality in the developed countries. CHD involves a very broad clinical spectrum, ranging from stable angina pectoris to sudden cardiac death. Despite a huge improvement in treatment in the last 3 decades, significantly reducing the death rate, the prevalence of CHD will increase in the coming years due to an improved survival after a first acute myocardial infarction and due to an overall increased longevity, fueled by an epidemic of type-2 diabetes and obesity. This increased prevalence of cardiovascular disease will greatly impact the cost of health care. Moreover, new but often expensive imaging technologies are appealing for more accurate clinical and preclinical detection of CHD. Among these techniques, magnetic resonance imaging (MRI) is certainly one of the most promising. In this review we would like to highlight its potential in diagnosing CHD, against the background of a steadily increasing cost in health care and the need to choose the most cost-effective technique.