Psoriasis is a chronic immune-mediated disease affecting the skin, nails, and/or joints. It is associated with systemic inflammation and may also be linked to an increased risk of atherosclerotic cardiovascular disease (ASCVD). A systematic review and meta-analysis of observational studies were used to determine the overall risk of ASCVD in patients with psoriasis and to evaluate the risk according to ASCVD type and the severity of psoriasis. Five electronic databases (MEDLINE via PubMed, EMBASE, Scopus, BASE, and Google Scholar) were searched for relevant studies in the English language from the beginning of their records to July 2023. Twenty-one observational studies (three cross-sectional, one case-control, and 17 cohort) were included in the review, representing a total of 778,049 patients with psoriasis and 16,881,765 control subjects without psoriasis. These studies had varying degrees of covariate adjustment, and thus, their findings may have been subject to residual confounding. Meta-analyses used the adjusted effect sizes and were based on the random-effects model. There was a significant association between psoriasis and ASCVD (cohort studies: hazard ratio (HR), 1.21; 95% confidence interval (CI), 1.14 to 1.28; I2 = 63%; p < 0.001; non-cohort studies: odds ratio (OR), 1.60; 95% CI, 1.34 to 1.92; I2 = 31%; p = 0.23). Psoriasis was also significantly associated with myocardial infarction, coronary artery disease, aortic aneurysm but not with ischaemic stroke. Pooled analysis in terms of the severity of psoriasis showed that both mild (cohort studies: HR, 1.17; 95% CI, 1.08 to 1.26; I2 = 74%; p < 0.001; non-cohort studies: OR, 1.54; 95% CI, 1.25 to 1.90; I2 = 0%; p = 0.50) and severe (cohort studies: HR, 1.43; 95% CI, 1.23 to 1.65; I2 = 65%; p < 0.001; non-cohort studies: OR, 1.65; 95% CI, 1.29 to 2.12; I2 = 25%; p = 0.26) psoriasis were significantly associated with ASCVD.