Recent advances have solidified our understanding that psoriasis is an important systemic inflammatory disease. Specifically, characterization of the inflammatory cells and the cytokine milieu, as well as an appreciation of increased cardiovascular risk factors, vascular disease, and mortality, has been profound. In this issue of the Archives, Love and colleagues remind us of the presence of these important cardiovascular risk factors, some of which cluster as the so-called metabolic syndrome. They estimate that nearly 2.7 million adults with psoriasis in the United States have the metabolic syndrome, representing a unique challenge and an opportunity.