Objectives: Non-HDL-cholesterol (non-HDL-C) is considered as a predictor of cardiovascular risk and outcomes in general population. However, dialysis patients show inconsistent association between serum cholesterol and mortality due to the presence of protein energy wasting and inflammation. Recently, a high visit-to-visit variability in cholesterol suggested to lead to the fluctuations in the composition of atherosclerotic plaques and link to cardiovascular events. This study is aimed to stratifying cardiovascular risk with the mean and variability of non-HDL-C in patients undergoing hemodialysis. Methods: A total of 457 hemodialysis patients who had no history of myocardial infarction (MI) or stroke and who underwent ≥5 lipid profile at the seven university hospitals in South Korea between Mar 2009 and Dec 2019 were included. Sex-specific quartiles of non-HDL-C mean were used. Visit-to-visit non-HDL-C variability was calculated using the coefficient of variation, variability independent of the mean and average real variability. The low mean and high variability groups were defined as the lowest and highest quartiles of non-HDL-C mean and variability, respectively. The endpoints of the study were newly diagnosed MI, stroke, or all-cause death. Results: The incidence of MI was significantly higher in the low mean/high variability group than in other 3 groups. In addition, multivariable cox regression analysis demonstrated that age (hazard ratio (HR) 1.053, 95% confidence interval (CI) 1.024-1.082) and low mean/high variability group were independent risk factor for MI (HR 3.311, 95% CI 1.380-7.944). When the subjects were divided into quartile groups, neither mean nor variability of non-HDL-C was associated with MI, stroke, and all-cause mortality. Conclusions: Our results suggested that the combination of low mean and high variability of non-HDL-C is associated with an increased risk of MI in hemodialysis patients, while the mean and variability per se could not stratify cardiovascular risk.