Norwegian renal transplant recipients have a high prevalence of cardiovascular disease. In this group of patients cardiovascular disease causes three out of four deaths. Well-known risk factors such as hypertension, dyslipidemia, impaired glucose tolerance and diabetes mellitus are common in renal transplant recipients, but these factors cannot fully explain the high cardiovascular morbidity and mortality. Atherosclerotic disease and left ventricular hypertrophy are highly prevalent in uremic patients before transplantation. Hyperhomocysteinemia, elevated levels of advanced glycosylated end products, and immunosuppressive medication may also accelerate the atherosclerotic process. Until results from controlled trials on the effect of lipid-lowering therapy in renal transplant recipients are available, treatment decisions must be based on studies in non-transplanted patients. Every patient should be treated individually with the overall risk pattern taken into account.