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Objectives Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in Systemic Lupus Erythematosis (SLE) due to both traditional risk factors and disease-specific mechanisms. However, CVD risk assessment in these patients remains challenging. Prediction tools like SCORE2, designed for European populations, and QRISK3, which incorporates other variates such as diagnosis of SLE and corticosteroid use, may offer complementary insights.This study aimed to compare SCORE2 with QRISK3 to estimate CVD risk in SLE patients.Methods We conducted a retrospective observational study including SLE patients from our center, registered in Reuma.pt, aged 40–69 years. SCORE2 classification followed age-specific thresholds: low-to-moderate (<2.5% for <50 years; <5% for 50–69), high (2.5–7.5% for <50; 5–10% for 50–69), and very high (>/= 7.5% for <50; >/= 10% for 50–69). For QRISK3, <10% was considered low-to-moderate and >/= 10% high risk. Data from the last recorded appointment were included in the analysis. Within-patient differences were analyzed using the McNemar test. A p-value <0.05 was considered statistically significant.Results 136 patients were included, 130 (95.6%) female, with a median age of 54 years (IQR 13). CVD risk factors included hypertension (46.3%), dyslipidemia (43.4%), type 2 diabetes (11%), and active smoking (16%). Regarding Body Mass Index, 33.8% were overweight and 25% obese. Corticosteroid therapy was reported in 62.5% of patients, at a median dose of 2.5 mg/day (IQR 5). QRISK3 classified 44.1% of patients as high risk, compared with 22.8% according to SCORE2 (p< 0.001). SCORE2 identified all patients with type 2 diabetes as very high risk; these patients were excluded from the main analysis. Among patients classified as having low-to-moderate risk by SCORE2 (n=105), QRISK3 reclassified 32 individuals as high risk.Conclusions QRISK3 may provide a more accurate risk estimate in this population as it incorporates disease-specific variables. These findings underscore the need to refine and adapt CVD risk assessment tools for SLE patients, enabling earlier identification, closer monitoring, and more aggressive preventive and therapeutic strategies to improve long-term outcomes.