The objective of investigation was to study the prevalence and special features of atherosclerosis of coronary arteries (CA) and associated ischemic heart disease (IHD) in patients with systemic lupus erythematosus (SLE), to suggest rational algorithm of IHD diagnosis in these patients. We studied autopsy protocols and case histories of 33 patients who had died because of SLE and 100 current patients with SLE. In order to detect calcification of CA we used multidetector computed tomography (MDCT), for diagnosis of IHD – treadmill test and stressechocardiography with dipyridamole. Among patients who had died, the signs of aortic atherosclerosis were found in 51.5%, CA – in 39.4%, the CA stenosis was registered in every fifth dead patient. MDCT data detected calcification of CA in 39% of patients with SLE. Mean values of calcium index indicated mild calcification. The degree of calcification in different areas of СА decreased in such sequence: left anterior descending – left main – right – left circumflex. IHD diagnosis was based on three methods and was established in 21 patients with SLE (53.8% from the number of patients with the positive results of MDCT). The clinical signs of IHD were present in 11 patients. For the timely detection of IHD in patients with SLE we recommend the following algorithm of diagnosis: MDCT may be used as a screening test for diagnosis of atherosclerosis of CA; in patients with the positive results of MDCT the stress-echocardiography is more preferable for the diagnosis of IHD, because of higher diagnostic accuracy of this test, compared to the treadmill test (96.2% vs 55.3%).