Ankylosing spondylitis (AS) is a systemic inflammatory rheumatic disease characterized primarily by axial joint involvement, sacroiliitis and various extra-articular manifestations. High cardiovascular mortality in AS has led many researchers to investigate possible risk factors involved with cardiovascular disease in these patients. This review summarizes published data concerning endothelial dysfunction and atherosclerosis in patients with AS. The author discusses current limitations and problems related to a better assessment of these two possible changes in AS.