Cardiovascular disease (CVD) and cancer frequently coexist in older patients, posing significant challenges in clinical management due to overlapping risk factors and treatment-related complications. This narrative review summarizes current knowledge on the epidemiology, shared pathophysiological mechanisms and clinical impact of neoplastic comorbidities in older adults with cardiovascular diseases. It highlights the increased mortality, morbidity and diminished quality of life resulting from the coexistence of these conditions. The review also discusses personalized management strategies, emphasizing comprehensive geriatric and cardiac assessments, and tailoring oncologic treatments to minimize cardiotoxicity, as well as the role of prevention and rehabilitation programs. As the population ages and cancer survival improves, integrated cardio-oncology care adapted to older adults becomes increasingly essential to optimize outcomes and preserve functional status.