One of the most compelling clinical challenges in the management of systemic lupus erythematosus (SLE) is the high incidence of atherosclerotic cardiovascular disease (ASCVD). Potential mechanisms for accelerated atherosclerosis in SLE include chronic inflammation, excess of traditional risk factors, and corticosteroid therapy. Given the high prevalence of atherosclerosis in SLE patients relative to young women in the general population, we propose that the presence of SLE constitutes a sufficiently potent risk factor for ASCVD to warrant more aggressive goals for risk factor reduction and strategies to reduce inflammation.