Psoriasis, Cardiovascular Risk, and Artificial Intelligence: Precision Risk Stratification Along the Skin-Vascular Axis-A Narrative Review

Psoriasis functions as a systemic inflammatory disorder associated with accelerated atherosclerosis via the Skin-Vascular Axis, conferring a cardiovascular (CV) risk frequently underestimated by conventional calculators. In this narrative review, we elucidate the mechanistic role of the IL-23/IL-17 pathway in vascular remodeling and highlight a critical clinical challenge: cutaneous-vascular dissociation, wherein profound skin clearance may not reflect internal vascular homeostasis. We evaluate the systemic CV impact of targeted therapies, highlighting the vasculo-protective potential and real-world observational evidence of biologics, the neutral-to-favorable cardiometabolic profile of oral PDE4 inhibitors, and the safety landscape of TYK2/JAK inhibitors. Furthermore, we assess the emerging clinical potential of Artificial Intelligence (AI) in cardio-dermatology, detailing how deep learning radiomics and novel multimodal fusion models incorporating biomarkers like GlycA can identify subclinical, vulnerable phenotypes. However, current evidence is largely derived from general cardiovascular cohorts, underscoring the need for disease-specific validation. Ultimately, we propose that AI-augmented tools should complement clinical judgment within an interdisciplinary framework to precisely stratify risk and potentially guide interventions to improve cardiovascular outcomes in psoriasis.