Chronic kidney disease (CKD) is a recognized risk multiplier for the development of cardiovascular disease (CVD), with CVD events representing the leading cause of morbidity and mortality in patients with CKD. The nature of CKD as a risk state relates both to the nature of CKD and the antecedent development of CVD. In addition, patients with CKD have increased rates of multiple conventional cardiac risk factors. Although early data regarding the relationship between CVD and CKD were limited because of the need for large data sets and multivariable analysis, the importance of recognizing this complex relationship is now clear. The essence of the relationship appears to be bidirectional, and therapy directed at improving natural history of chronic disease on one system generally improves prognosis in the other. Specifically, CVD outcomes have been shown to improve with the treatment of risk factors commonly found in association with CKD, including hypertension, diabetes, dyslipidemia, albuminuria, and smoking, as well as appropriate renin-angiotensin-aldosterone system blockade and antiplatelet therapy. Once hospitalized, management of acute coronary syndromes represents a key area of clinical investigation. The goal of this article is to highlight the importance of these topics in improving cardiovascular outcomes and use of appropriate treatment in CKD.