TNF and atherosclerosis: Chronic systemic inflammation is a central mechanism—the psoriatic immune milieu (e.g., activated T-cells, dendritic cells) leads to elevated cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-17, IL-23, and IL-6, which can promote endothelial dysfunction, vascular inflammation, and atherosclerosis (7, 8).