Objective. To verify the in vivo status of chylomi-cron metabolism in systemic lupus erythematosus (SLE) since there is a high incidence of atherosclerosis in this disease and chylomicrons may have an important role in atherogenesis. Methods. A chylomicron-like emulsion labeled with 14 C-cholesteryl esters and 3 H-triglycerides was injected intravenously into 10 female patients with inactive SLE and 10 healthy age-and sex-matched control subjects to determine the plasma kinetics of the emulsion lipids from consecutive plasma samples taken at regular intervals for 1 hour. Lipolytic activity was determined in vitro after incubation of the labeled emulsion with postheparin plasma. Results. The decay curves for the emulsion were markedly slowed in SLE. Chylomicron lipolysis, indicated by the fractional clearance rate (FCR) of emulsion 3 H-triglyceride, was 2-fold smaller in SLE patients than in controls (mean SD 0.023 0.011 versus 0.047 0.015 minute 1 ; P 0.010). Chylomicron removal, indicated by emulsion 14 C-cholesteryl ester FCR, was 3-fold smaller in SLE patients than in controls (0.007 0.007 versus 0.023 0.011 minute 1 ; P 0.009). In vitro lipolysis in SLE patients was nearly half that of the controls (mean SD 10,199 2,959 versus 6,598 2,215; P 0.014). Higher levels of very-low-density lipoprotein cholesterol and triglycerides and lower levels of high-density lipoprotein cholesterol and apoli-poprotein A-I were also observed in the SLE patients. Conclusion. SLE patients have disturbances in chylomicron metabolism that are characterized by decreased lipolysis and chylomicron remnant removal from the plasma. This finding, together with other alterations in lipid profiles that were confirmed in the present study, is largely accountable for the accelerated atherosclerotic process of the disease.