There is strong evidence that patients with antiphospholipid syndrome have an increase risk of early development of cardiovascular events with resulting mortality. However, the existence of specific mechanisms of atherogenesis in antiphospholipid syndrome may affect cadiovascular risk assessment. The main purpose of this study was to evaluate the risk of coronary events by the most common rating scales, to compare it with traditional and specific risk factors and to investigate correlation of individual risk of vascular lesions with its actual state. The study included 77 patients with antiphospholipid syndrome and 37 age- and sex-matched healthy subjects. Traditional risk factors such as dyslipidemia, obesity, arterial hypertension age, sex, diabetus mellitus, sedentary lifestyle were assessed in each participant. State of the cardiovascular system was evaluated on the basis of laboratory and instrumental examination. To identify patients with silent myocardial ischemia daily ECG monitoring was used. We investigated plasma levels of total cholesterol, triglycerides, high-density lipoprotein, TNF-α, CRP, paraoxanase activity, IL-1, anticardiolipin antibodies IgG and anti-b2-glycoprotein antibodies. In addition, we evaluated flow-mediated vasodilation of brachial artery, assessed thickness of intima-media complex of the common carotid artery and the presence of atherosclerotic plaques in the common carotid artery. Risk stratification of cardiovascular events was performed by using Framingham, SCORE and Reynolds scales. Individual risk of cardiovascular lesions in patients with antiphospholipid syndrome was 1.65–2.78 times higher than in the general population. Significant differences of the cardiovascular risk measured by different scales were established: 39 % high risk individuals have been registered by SCORE scale, compared to 14.3 % patients by Framingham and 20.8 % patients by Reynolds scale. The main factors increasing individual cardiovascular risk in patients with antiphospholipid syndrome were dyslipidemia, high blood pressure, male gender, diabetes mellitus and smoking. SCORE scale does not reflect the real state of the cardiovascular system in patients with antiphospholipid syndrome, estimated by instrumental methods. In conclusion, it is necessary to develop new algorithms of cardiovascular risk assessment in patients with antiphospholipid syndrome based on the specific risk factors.