Despite obvious advances in the understanding of the etiopathogenesis of lupus and overall improvements in the care of the patients afflicted with this disorder, our patients still accrue damage, have a shorter life expectancy, and experience premature atherosclerosis. Damage is a function of active disease and the treatments used to ameliorate or control the activity of the disease. Mortality is a function of age, damage, and SES but not of ethnicity. Premature atherosclerosis is a function of the combination of disease-related and traditional risk factors. So what can we do in terms of cardiovascular prevention? First, we need to work on the traditional risk factors; for example 13.6% of patients in our cohort smoke and the proportion of smokers is even higher in other cohorts. Hypertension, sedentarism, dyslipidemia, and obesity need also to be addressed. But there are still unresolved questions; should all lupus patients take aspirin and statins? What is the optimal dose of glucocorticoids? Should we be more aggressive in treating patients with immunosuppressive therapy to decrease the activity of the disease and prevent damage and therefore improve survival? Bruce specifically recommends that all lupus patients who are aPL positive, hypertensive or dyslipidemic should be on low-dose aspirin and statins unless there is an explicit contraindication for their use. He also recommends to treat LDL cholesterol levels above 130 mg/dL in lupus patients without other risk factors but to use 100 mg/dL as the cutoff if other risk factors are present. Petri et al. presented the preliminary results of a clinical trial of atorvastatin versus placebo which included 187 lupus patients at the 2006 meeting of the ACR; end points for this trial were carotid IMT, coronary calcifications by helical computed tomography, and disease activity. Although patients treated with atorvastatin exhibited less carotid IMT progression than the comparison group, coronary artery calcifications and disease activity occurred at the same rate in both groups. Thus, before the recommendations by Bruce and others are adopted, more definitive data are needed. The overall prognosis of a patient diagnosed with lupus nowadays is much better than that of a patient diagnosed decades ago. Moreover, as our understanding of lupus improves and targeted therapies are developed, the challenge for us rheumatologists is to be able to conduct the trials that will test and eventually bring newer treatment options to our patients. In the meantime, rheumatologists should work diligently with other health care providers to ameliorate the ravages caused by the disease and the therapies used to bring it under control. Copyright © 2007 by Lippincott Williams & Wilkins.