The Study of Heart and Renal Protection (SHARP) indicated that simvastatin/ezetimibe combination therapy reduces the risk of major atherosclerotic events (coronary death, MI, non-hemorrhagic stroke, or any revascularization) compared with placebo in people with GFR categories G3a G5.22 These data are supported by post hoc analyses of randomized trials of statin versus placebo that focus on the subset of participants with CKD at baseline. In general, these analyses suggest that statins reduce the relative risk of cardiovascular events to a similar extent among patients with and without CKD, but that the absolute benefit of treatment is larger in CKD patients because of their higher baseline The Work Group concluded that the combination of findings from SHARP, post hoc analyses of trials from the general population (focusing on the subset of partici- pants with CKD), and the large body of evidence from the C review general population trials collectively justify a strong recom- mendation. RESULTS FROM TRIALS IN THE GENERAL POPULATION AND COMORBIDITY HAD IMPACT ON A STRONG RECOMMENDATION IN YOUNGER AGE AND EARLIER STAGES OF CKD Most patients with CKD and eGFR X60 ml/min per 1.73 m2 have albuminuria and slightly reduced or normal eGFR; most of these would have been included but not recognized in trials of statins performed in the general population. The benefit of statin monotherapy appears similar in people with and without albuminuria.24,25 Given these data, the high cardiovascular risk among people with CKD and eGFR categories G1 G2, the large body of evidence supporting the efficacy of statins in the general population, and the lack of justification for a new trial performed specifically in people with CKD and eGFR categories G1 G2, the Work Group judged that a strong recommendation was appropriate. 