The prevalence of atherosclerotic vascular events (AVE) in a systemic lupus erythematosus (SLE) inception cohort in published literature is 10%.1 However this represents only clinically diagnosed events and gives no indication of the predisposition to such events. Furthermore there has been no study of changing prevalence of AVE over the past decades to the present. In this presentation the past prevalence AVE in the University of Toronto Lupus Cohort (UTLC) and the SLICC inception cohort will be described.2 It will then review the approaches for detecting subclinical atherosclerotic changes in SLE patients, which are the possible precursors to clinical events.3 Then the occurrence of AVE in patients with SLE prior to their diagnosis or in the first 2 years after their SLE diagnosis will be presented.4 5 Studies of incidence AVE in the systemic lupus international collaborating clinics (SLICC) cohort are dramatically lower than previously reported. However this cohort includes only inception cohorts seen in the current millennium. The UTLC was then studied for inception patients seen in two eras 1975–1987 and 1999–2011 and then followed for 6 years thus mirroring the SLICC cohort. Similar to the SLICC results the late UTLC revealed a four-fold decrease in AVE compared to its earlier cohort. This will be shown to be due in large part to the more effect management of the classic cardiovascular risk factors in the modern era. This offers significant hope for reducing the impact of this co-morbidity in patients with SLE. Learning objectives Describe the extent of clinical, subclinical and preclinical AVE in patients with SLE. Discuss the magnitude of the improvement in the incidence of AVE in patients with SLE in the modern era Explain the importance of effectively managing the classic cardiovascular risk factors in patients with SLE to minimize the occurrence of AVE References Sheane BJ.,Urowitz MB, Gladman DD, Atherosclerosis in Systemic Lupus Erythematosus – Epidemiology, Risk Factors, Subclinical Assessment and Future Study. Rheumatology: Current Research 2013;s5(01). Urowitz MB, Su J Gladman DD. Atherosclerotic Vascular Events in Systemic Lupus Erythematosus: An Evolving Story. The Journal of Rheumatology 2019, jrheum.180986. Tselios K, Sheane BJ, Gladman DD, Urowitz MB Optimal Monitoring For Coronary Heart Disease Risk in Patients with Systemic Lupus Erythematosus: A Systematic Review. The Journal of Rheumatology 2016;43(1):54–65. Urowitz MB, Gladman DD, Anderson NM, et al. Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort. Lupus Sci Med 2016;3(1):e000143. Tselios K, Gladman DD, Su J, et al. Evolution of Risk Factors for Atherosclerotic Cardiovascular Events in Systemic Lupus Erythematosus: A Longterm Prospective Study. The Journal of Rheumatology 2017;44(12):1841–49.