Apolipoprotein (Apo)-B is a strong predictor of coronary risk in the general population. Whether it contributes to coronary disease in patients with reduced kidney function is unclear. We examined the prevalence and relationship of Apo-B with physician-diagnosed myocardial infarction among 7,404 adults age >20 years with reduced glomerular filtration rate (GFR) in the U.S. population. GFR was estimated Modification of Diet in Renal Disease Study (MDRD) equation and calibrated for use in NHANES III. Prevalence of Apo-B levels >75th Centile (>120 mg/dL) were estimated for each GFR level for the entire population and those with and without MI. Multivariable logistic regression was used to assess the association of Apo-B levels in quartiles with MI. Apo-B levels (>75th Centile) increased as renal function declined in the overall population. Apo-B levels were generally higher in persons with a history of MI compared to those without MI at all levels of GFR but especially among those with GFR <30 mls/min. Adjusting for GFR, the likelihood of MI progressively increased from the 1st to the 4th Quartile of Apo-B levels. While Apo-B was significantly associated with prevalent MI, much of this association could be explained by the presence of the known Framingham risk factors (diabetes, hypertension, age, sex, cholesterol, smoking, physical inactivity). Apo-B levels were significantly associated with coronary disease amongst patients with reduced GFR. this can be explained by the Framingham risk factors. In conclusion, further prospective studies would evaluate cardiovascular risk of reduced Apo-B in CKD and whether strategies aimed at reducing levels can improve cardiovascular outcomes.