Further inspection of the absolute risks indicate that participants aged 40 50 years have average rates of CHD death or incident MI that are consistently less than 10 per 1000 patient-years. Case-fatality rate following myocardial infarction. Multiple studies demonstrate that the risk of death following MI is increased among people with CKD, as compared to otherwise comparable people with normal kidney function.27 The absolute risk of death is especially high in patients treated with chronic dialysis.28 Evidence that pharmacological cholesterol-lowering treatment is beneficial. The evidence supporting the clinical benefits of statin treatment in adults (alone or in combination with ezetimibe) differs substantially by severity of CKD. This evidence is presented in Supplemental Tables 6 18 online and summarized below. Collectively, available evidence argues against the use of LDL-C to identify CKD patients who should receive cholesterol-lowering treatment and suggests focusing instead on two factors: the absolute risk of coronary events, and the evidence that such treatment is beneficial. This is the approach taken in the recommendations that follow. Prior studies convincingly demonstrate that treatments to prevent cardiovascular events are systematically underused in CKD populations despite their high baseline risk.29 31 This suggests that a concerted attempt will be required to identify and treat CKD patients that are likely to benefit from lipid-lowering therapy. How should the dose of pharmacological cholesterol- lowering treatment be determined in CKD patients? Guidelines for the general population recommend that (among patients receiving statin treatment), the dose of statin is titrated to achieve the target level of LDL-C, which in turn is determined by each patient s presumed coronary This approach is widely accepted, although it has never been shown to lead to clinical benefit in a RCT. 