Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that mainly affects young women, a group usually free of atherosclerosis. As treatment for SLE has improved during recent years and long term survival increased, it has become clear that patients with SLE have increased morbidity and mortality from atherosclerotic cardiovascular disease. Several imaging techniques showed increased prevalence of premature atherosclerosis which was most striking in young patients with SLE. Pathogenesis of atherosclerosis is an inflammatory process. Inflammatory cells and mediators play a key role in the pathogenesis of atherosclerosis. Systemic inflammation and immune dysfunction are thought to accelerate atherosclerosis in patients with SLE as well. Several possible reasons for accelerated atherosclerosis in SLE have been suggested. Traditional coronary risk factors, other coronary risk factors including lipoprotein (a), CRP, homocysteine, inflammatory cytokines, increased vascular damage, lupus related factors and medications may affect the development of atherosclerosis in SLE. Atherosclerosis risk assessment, preventive strategy for accelerated atherosclerosis and its treatment would be required in patients with SLE.