This narrative review explores the implications of cardiopulmonary risk in the management of chronic obstructive pulmonary disease (COPD). COPD is a major global health burden, being the third leading cause of death worldwide. Patients with COPD often have cardiovascular disease, and COPD itself is a risk factor for adverse cardiovascular outcomes. COPD exacerbations can lead to reduced lung function, increased risk of future exacerbations, and cardiovascular events that may result in early death. The review defines cardiopulmonary risk as the risk of serious respiratory and/or cardiovascular events in patients with COPD, including exacerbations, myocardial infarction, stroke, heart failure, arrhythmia, and death due to these events. The review highlights that COPD is an independent predictor of cardiovascular disease, with a higher prevalence of cardiovascular risk factors in COPD patients compared to those without COPD. Exacerbations of COPD are associated with increased cardiovascular risk, and this risk may persist for up to a year after an exacerbation. Evidence suggests that triple therapy (ICS/LAMA/LABA) is effective in reducing exacerbations and cardiovascular events in COPD patients. Inhaled therapies, including bronchodilators and corticosteroids, have shown benefits in reducing exacerbations and improving cardiovascular outcomes. The review emphasizes the need for a proactive approach to managing cardiopulmonary risk in COPD, including early identification of high-risk patients and the use of appropriate therapies. It also highlights the importance of considering cardiovascular risk in the management of COPD, as it is a significant contributor to mortality. The review concludes that proactive management of cardiopulmonary risk can improve clinical outcomes in COPD patients.This narrative review explores the implications of cardiopulmonary risk in the management of chronic obstructive pulmonary disease (COPD). COPD is a major global health burden, being the third leading cause of death worldwide. Patients with COPD often have cardiovascular disease, and COPD itself is a risk factor for adverse cardiovascular outcomes. COPD exacerbations can lead to reduced lung function, increased risk of future exacerbations, and cardiovascular events that may result in early death. The review defines cardiopulmonary risk as the risk of serious respiratory and/or cardiovascular events in patients with COPD, including exacerbations, myocardial infarction, stroke, heart failure, arrhythmia, and death due to these events. The review highlights that COPD is an independent predictor of cardiovascular disease, with a higher prevalence of cardiovascular risk factors in COPD patients compared to those without COPD. Exacerbations of COPD are associated with increased cardiovascular risk, and this risk may persist for up to a year after an exacerbation. Evidence suggests that triple therapy (ICS/LAMA/LABA) is effective in reducing exacerbations and cardiovascular events in COPD patients. Inhaled therapies, including bronchodilators and corticosteroids, have shown benefits in reducing exacerbations and improving cardiovascular outcomes. The review emphasizes the need for a proactive approach to managing cardiopulmonary risk in COPD, including early identification of high-risk patients and the use of appropriate therapies. It also highlights the importance of considering cardiovascular risk in the management of COPD, as it is a significant contributor to mortality. The review concludes that proactive management of cardiopulmonary risk can improve clinical outcomes in COPD patients.