In clinical practice, arteriosclerotic heart disease has not been recognized as a complication of long-term corticosteroid treatment. Yet, an increasing body of evidence suggests that prolonged corticosteroid therapy accelerates the development of atherosclerosis. An important element in this process may be the fact that corticosteroids induce or exacerbate several known coronary risk factors, including hypertension, hypercholesterolemia, hypertriglyceridemia, and impairment of glucose tolerance. One group of patients that is often exposed to long-term corticosteroid treatment is that with rheumatoid arthritis. These patients have an increased mortality, with cardiovascular disease appearing to be a major contributor to this decreased survival. The weight of evidence relates the development of atherosclerosis to corticosteroid use. However, no long-term epidemiologic or morphologic studies have been performed to elucidate this issue. Until these are accomplished, prolonged therapy with this medication, particularly in younger persons, should be avoided whenever possible.