The relation between glomerular filtration rate (GFR) <60 ml/min/1.73 m(2) and the extent and progression of coronary atherosclerosis in 989 subjects with coronary artery disease was investigated. Despite being older, more likely to be women, and having a history of hypertension, diabetes, and bypass surgery, total atheroma volume and percent atheroma volume in subjects with a low GFR did not differ from subjects with a GFR >60 ml/kg/min. Similarly, there was no difference in progression rates of total atheroma volume and percent atheroma volume in patients with GFRs lower and higher than 60 ml/min/1.73 m(2) in response to a high rate of use of established preventive therapies. In conclusion, findings suggest that the increased incidence of clinical events in patients with impaired renal function may result from factors other than atherosclerotic burden.