The mortality rates from cardiac death are significantly higher in hemodialysis patients than in normal population. Coronary disease is probably a main cause of such cardiac death. The observation that ischemic heart disease is mostly acquired in pre-end-stage renal failure has been reported. The incidence of cardiac death on hemodialysis is increased compared to the general population by a factor 5-20. It is posutulated that hypertention and dyslipidemia are the major risk factors. However, there have been no reports demonstable between blood pressure and indices of endorgan damage from hypertention or between lipid abnormalities and clinical evidence of coronary disease or cardiac death. The relation between blood pressure and cardiac death is non-linear. There is no evidence that the treatment of dyslipidemia actually reduces the coronary risk. Recent observation that vitamin E, a antioxidant, may be effective for the prevention of aortic cacification in dialysis patients appears attractive, although further studies are required.