Background: Systemic inflammation beyond the skin may provide an explanation of the increased cardiovascular risk observed in psoriasis. It was hypothesized that neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are potential predictors of subclinical atherosclerosis measured by aortic velocity propagation (AVP) and carotid intima-media thickness (CIMT) in psoriasis. Methods: Fifty-one patients with psoriasis taking no antipsoriatic therapy and 37 age- and sex-matched healthy controls were prospectively enrolled. The Psoriasis Area and Severity Index (PASI) was calculated. Complete blood counts were obtained. Measurements of AVP and CIMT were performed. Results: The baseline clinical and demographic features, and white blood cell, platelet, neutrophil, lymphocyte, monocyte, and PLR were similar in both groups. NLR and high-sensitivity C-reactive protein (hs-CRP) were higher in the psoriasis group than the control group (P = 0.001, P < 0.001; respectively). The psoriasis group had lower AVP and higher CIMT values than those of controls (AVP: 48.9 +/- 18.1 vs. 64.3 +/- 14.5 cm/sec; P < 0.001, CIMT: 0.84 +/- 0.29 vs. 0.63 +/- 0.27 mm; P = 0.001, respectively). PASI was positively correlated with NLR and hs-CRP (r = 0.423, P = 0.002; r = 0.315, P = 0.024, respectively). There was an inverse association between AVP and CIMT (r = -0.749, P < 0.001). Binary logistic regression analysis demonstrated that NLR was the only variable able to predict lower AVP (= 41 cm/sec) and higher CIMT (>0.9 mm) values (P = 0.024 and 0.023; respectively). Conclusion: NLR is potentially an unrecognized predictor of subclinical atherosclerosis in patients with psoriasis. Future studies assessing the prognostic significance of NLR on cardiovascular event rates in psoriasis patients would be of great interest.