Associations between LDL-C and coronary artery disease in dialysis patients. Observational data indicate that dialysis patients with the highest and lowest levels of LDL-C and TC are at the highest risk of adverse outcomes such as all-cause and cardiovascular mortality.16 19 This paradoxical associa- tion between cholesterol and outcomes appears to be due to effect modification by protein energy wasting, inflammation which are all common in kidney failure and are themselves associated with a high risk of adverse outcomes. Put differently, patients with one of more of these three conditions are more likely to also have low cholesterol, which confounds the apparent association between cholesterol and the risk of cardiovascular death. Although cardiovascular risk is increased in dialysis patients with higher LDL-C and TC, elevated cholesterol seems unsuitable as the criterion for statin prescription in patients with kidney failure because it will fail to identify those with low cholesterol who are also at high risk. Associations between LDL-C and coronary artery disease in CKD patients with eGFR Z15 ml/min/1.73 m2 . As eGFR declines, the magnitude of the excess risk associated with increased LDL-C decreases. For instance, the hazard ratio [HR] (95% confidence interval [CI]) of incident myo- cardial infarction (MI) associated with LDL-C 44.9 mmol/l [4190 mg/dl] (as compared to 2.6 3.39 mmol/l [100 (1.59 2.67) for people with eGFR of Z90, 60 89.9 and , respectively. Figure 1 shows the relation between LDL-C and the risk of hospitalization for MI for selected values of baseline eGFR. The figure shows that the relation between LDL-C and the risk of MI appears linear at LDL-C above 2.6 mmol/l (100 mg/dl). 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. 