BACKGROUND: Early-stage chronic kidney disease (CKD), a marker of cardiovascular risk, is susceptible to therapeutic intervention but need further study in populations with low incidence of coronary heart disease (CHD). Incorporating glomerular filtration rate (GFR) could improve cardiovascular risk prediction in these patients. OBJECTIVE: To determine if decreased GFR is associated with increased risk of cardiovascular morbidity and all-cause mortality and to analyse GFR effect on cardiovascular risk prediction in a population with low CHD incidence. METHODS: Retrospective, observational, population-based study of 1,081,865 adults (35-74years old). Main exposure variable: GFR. OUTCOMES: CHD, cerebrovascular disease, cardiovascular diseases, all-cause mortality. Association between GFR categories of CKD (G1-G5) and outcomes was tested with Cox survival models. G1 was defined as the reference category. Predictive value of GFR was evaluated by integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices. RESULTS: Beginning at stage-3a CKD, increased risk was observed for coronary (HR 1.27 (95%CI 1.14-1.43)), cerebrovascular (HR 1.19 (95%CI 1.06-1.34)), cardiovascular (HR 1.23 (95%CI 1.13-1.34)) and all-cause mortality risk (HR 1.17 (95%CI 1.07-1.27)). GFR did not increase discrimination and reclassification indices significantly for any outcome. CONCLUSION: In general population with low CHD incidence and stage-3 CKD, impaired GFR was associated with increased risk of all cardiovascular diseases studied and all-cause mortality, but adding GFR values did not improve cardiovascular risk calculation. Despite a four-fold higher rate of CHD incidence at GFR G3a compared to G1, this represents moderate cardiovascular risk in our context. ; This project was supported by grants from the Spanish Government's 2011 Health Ministry call for clinical research proposals (EC11-349), the 2012 Ministry of Science and Innovation call through the Carlos III Health Institute (Net RD12/0005/0002), and the 2013 call from the Carlos III Health Institute for clinical research proposals related to the Health Strategic Action Plan, 2013–2016, under the Program on Research Related to Society's Challenges, within the framework of Spain's 2013–2016 Plan for Scientific and Technical Research and Innovation (PI13/01,511, co-funded by the European Fund for Regional Development (EFRD) of the European Union). Additional funding was provided by the 2012 IDIAP Jordi Gol scholarship call (9è ajut a l'impuls d'estratègies de recerca a l'atenció primària mitjançant la intensificació d'investigadors). M.G. is funded by a FEDER contract from Carlos III Health institute (FIS CP12/03287).