Background Since inflammation has a major role in atherothrombosis, measurement of inflammatory markers like high-sensitivity C-reactive protein (Hs-CRP) may provide a method for detecting the high risk of cardiovascular disease (CVD) in patients with lichen planus (LP). Predicting the cardiovascular risk factors in patients with LP would allow appropriate preventive measures to be applied. Many studies have tried to link LP with atherosclerosis with conditions like dyslipidemia, carotid intimal media thickness, or epicardial adipose tissue; however, this link is still a matter of debate. Objective To assess the risk of atherosclerosis in LP patients by different means including dyslipidemia, metabolic syndrome, Hs-CRP/adiponectin ratio, ECG changes, and atherosclerotic CVD risk estimator. Patients and methods This study included 40 patients with LP with 40 age-matched and sex-matched healthy controls. Peripheral venous blood samples were withdrawn from the patients and controls to measure serum levels of Hs-CRP, adiponectin, fasting blood sugar, and lipid profile. Hs-CRP/adiponectin ratio was calculated and the criteria of metabolic syndrome were assessed. Atherosclerotic CVD risk estimator was measured and ECG was done for patients and controls. Results Patients with LP showed significant higher Hs-CRP/adiponectin ratio (0.62 ± 0.22) in comparison to controls (0.05 ± 0.02). A significant increase in low-density lipoprotein cholesterol was noticed in patients (165 ± 38.3) than in controls (122 ± 22); moreover, serum cholesterol was significantly increased in patients (251.7 ± 44) than in controls (195.2 ± 22.2) with the number of patients with LP that had metabolic syndrome [22 (55%) patients] being significantly more than controls with metabolic syndrome [six (15%) controls]. Conclusion Patients with LP have an increased risk of metabolic syndrome, atherosclerosis, and cardiovascular disorders. Hs-CRP/adiponectin ratio is a good predicator for the assessment of risks of atherosclerosis in patients with LP.