Premature atherosclerosis has been observed during the course of different systemic inflammatory diseases, such as rheumatoid arthritis (RA), systemic lupus erythematosus, and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).1-3 As a result, cardiovascular (CV) events, including myocardial infarction, stroke, heart failure, coronary artery disease, and death, occur 1.65 to 3 times more commonly in patients with AAV as compared to the general population, and the risk appears to be highest in the first year following diagnosis.3 After the first year, however, CV disease (CVD) remains the most important cause of death besides malignancy and infection. It has been demonstrated that traditional risk factors for CVD, such as hypertension, dyslipidemia, diabetes, age, and a family history of CVD, are highly prevalent in AAV. In this issue of The Journal of Rheumatology , Moiseev et al demonstrated that smoking and pulmonary involvement were also associated with an increa