A recent study suggested that patients with chronic kidney disease (CKD) with a glomerular filtration rate (GFR) < 45 ml/min/1.73 m(2) are more likely to present with acute myocardial infarction (AMI) than with stable exertion angina. Thus, the degree of renal impairment seems to be related to the presentation of coronary heart disease (CHD). In this context, there is evidence indicating that statins decrease the excess risk for AMI and other CHD-related events in patients with CKD (although the benefit may depend on the stage of CKD). This effect might be attributed to stabilization of atherosclerotic plaques, which seem to be more vulnerable if CKD is present. Thus, statin treatment in early CKD, a condition considered to be a CHD equivalent by several guidelines, is likely to minimize the risk for CHD events.