Cardiovascular complications are increasingly recognised as a major cause of morbidity and mortality in SLE. The incidence of myocardial infarction is elevated 8 to 50-fold compared to age and gender matched controls. Traditional cardiovascular risk factors are increased in SLE, and are associated with both preclinical and clinical atherosclerosis. However, even after adjustment for traditional risk factors, a large difference in the frequency of cardiovascular disease exists between SLE patients and controls. In the general population, atherosclerosis is now recognised as a chronic inflammatory condition, with elevations of C-reactive protein and IL-6. TNF has a role in the pathogenesis of congestive heart failure. These and other inflammatory cytokines likely play a role in SLE. Furthermore, SLE patients are hypercoagulable secondary to antiphospholipid antibodies and other factors. Thus, the pathogenesis of cardiovascular complications in SLE is likely multifactorial, with both SLE and traditional risk factors playing a role.