The HR (95% CI) of MI associated with each 1 mmol/l (39 mg/dl) increase in LDL-C above 2.6 mmol/l , respectively. The weaker and potentially misleading associa- tion between LDL-C and coronary risk among those with lower levels of kidney function (a group who is at the highest absolute risk) argue against its use for identifying CKD patients who should receive pharmacological cholesterol- lowering treatment. Which CKD patients should receive pharmacological cholesterol-lowering treatment? To maximize the ratio of benefits to harms and costs, contemporary clinical practice emphasizes three potential determinants of the decision to prescribe lipid-lowering treatment in people with normal kidney function: baseline coronary risk; case-fatality rate following MI; and evidence that lipid-lowering treatment is beneficial.23 Baseline coronary risk. The 10-year incidence risk of coronary death or non-fatal MI (numerically equivalent to the rate of such events per 1000 patient-years) is often used as http://www.kidney-international.org chapter 2 & 2013 KDIGO Hazard ratio LDL-C, mmol/l Hazard ratio LDL-C, mmol/l Hazard ratio LDL-C, mmol/l Hazard ratio LDL-C, mmol/l Hazard ratio LDL-C, mmol/l Figure 1 | Adjusted relation between LDL-C and HR of myocardial infarction by eGFR as a continuous variable. Data are adjusted hazard ratios for MI during a median follow-up period of 48 months. Data are from 836,060 participants in the Alberta Kidney Disease cohort and have been adjusted for age, sex, diabetes, hypertension, Aboriginal status, socioeconomic status, proteinuria categories, statin use, and the Charlson comorbidities (cancer, cerebrovascular disease, congestive heart failure, chronic pulmonary disease, dementia, metastatic solid tumor, MI, liver disease, hemiplegia/paraplegia, peptic ulcer disease, peripheral vascular disease, and rheumatic disease). eGFR, estimated glomerular filtration rate; HR, hazard ratio; LDL-C, low-density lipoprotein cholesterol; MI, myocardial infarction. Reproduced from Tonelli M, Muntner P, Lloyd A, et al. Association between LDL-C and Risk of Myocardial Infarction in CKD. 