Cardiovascular disease causes significant morbidity and mortality in rheumatoid arthritis (RA). Accelerated atherosclerosis caused by inflammation is the hallmark of cardiovascular disease in RA. Cardiac involvement as an extra-articular manifestation of RA is also prevalent but often subclinical. Treatment of RA also has implications on cardiovascular outcomes in RA. In this article, atherosclerotic and nonatherosclerotic cardiac manifestations in RA are discussed, with a focus on pathogenesis and management.