Vascular disease is present in every patient with scleroderma and is a major source of morbidity and mortality. There is a subset of patients who will develop severe and sometimes life-threatening vascular events. We have good evidence that an insult to the microvasculature occurs early in the disease course, but there is a subset of patients who have an ongoing chronic process, the end result of which are events such as digital loss and pulmonary arterial hypertension. The ability to detect this process at an early stage by simple means would be of great value as our ability to treat these vascular complications improves with time. We have a significant amount of evidence of vascular perturbation from studies of peripheral blood in scleroderma, but know very little about the ability of these biomarkers to predict vascular outcomes. In this review, we will critically assess our current knowledge of the use of biomarkers of vascular disease in scleroderma and the possible directions of future research in this area.