Cardiovascular disease is the leading cause of morbidity and mortality in the elderly. Managing cardiovascular risk in this group is uniquely challenging due to physiological changes, multimorbidity, polypharmacy, and frailty, compounded by the under-representation of older adults in clinical trials Recent advances, including the SCORE2-OP risk stratification tool and emerging therapies such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, have reshaped approaches to risk reduction. This review synthesizes the latest evidence and guideline recommendations for the management of hypertension, dyslipidaemia, diabetes, obesity, and antithrombotic therapy in older patients, with particular attention to frailty, adherence challenges, and individualized care. By addressing the complexities of cardiovascular risk management in older adults, this paper provides a practical framework for clinicians navigating this critical area.