Although the absolute rate of such events is lower among people with CKD who are less than 50 years of age, the co- existence of other risk factors increases the rate of coronary death or non-fatal MI substantially. In the subset of CKD patients aged o50 years with diabetes or prior vascular disease (MI, coronary revascularization, stroke or transient ischemic attack), the rate of coronary death or incident MI (Figure 2). In the judgment of the Work Group, this rate is sufficiently high to warrant statin treatment. Similarly, some CKD patients aged 18 50 years may not have diabetes or prior vascular disease but yet have multiple cardiovascular risk factors that substantially increase their risk of future coronary events. In the judgment of the Work Group, an estimated 10-year incidence of coronary death or non-fatal MI is sufficiently high to warrant statin treatment. Since unequivocally elevated LDL-C does appear to confer an increased risk of coronary events in people with CKD (although to a lesser extent than in the general population), increased LDL-C levels should be considered when estimating coronary risk in CKD patients aged o50 years. The 10-year incidence of coronary death or non-fatal MI may be estimated using any validated risk prediction tool such as the Framingham risk score,38 or the QRISK2.42 Overall, these instruments tend to overestimate future coronary risk and usually incorporate information on LDL-C. However, since most do not explicitly consider the presence of CKD, which would be expected to increase coronary risk for any given set of traditional cardiovascular risk factors, such overestimation should be less pronounced in CKD populations. 