The current concept of coronary risk reduction for the general population involves matching the intensity of the intervention to the intensity of the risk. In an evidence-based model, two components must be addressed: the strength of evidence of the risk of each attribute and the efficacy of specific interventions, both lifestyle modifications and pharmacotherapy. This format guides national recommendations for the control of lipid abnormalities and for physical activity for the general population. In the absence of randomized trial data for postmenopausal hormone therapy, presentation of relative benefits and risks should be offered with individualization of advice based on the characteristics of the specific patient. Patients with chronic renal disease have a high prevalence of coronary risk factors and are at high risk for coronary heart disease. Goals for coronary risk factor intervention must be developed for patients with specific subsets of chronic renal disease.