This article summarizes knowledge of the pathogenic mechanisms in autoimmune rheumatic diseases as risk factors for accelerated atherosclerosis. The studies described support a role for immunologic-inflammatory mechanisms in the pathogenesis of atherosclerosis. This immunologic-inflammatory state is evident in many autoimmune diseases, but also in the general population lacking an overt autoimmune disease. The ability to immunomodulate atherosclerosis (currently only experimental) should lead to future research into the mechanisms and treatment of atherosclerosis, the leading cause of death in the Western world.