This narrative review defines cardiopulmonary risk as the risk of serious respiratory and/or cardiovascular events in patients with chronic obstructive pulmonary disease (COPD). It highlights the significant burden of COPD and its association with cardiovascular disease, emphasizing the need for proactive management to reduce this risk. The review discusses the elevated cardiopulmonary risk in COPD patients, which can lead to early death, and the importance of identifying and managing exacerbations to prevent adverse outcomes. It reviews current evidence supporting therapeutic interventions to reduce exacerbation risk and improve clinical outcomes, including the use of inhaled therapies such as triple therapy (ICS/LAMA/LABA). The review also explores the mechanisms by which these therapies may provide cardiopulmonary protection and the need for early detection and treatment of COPD in patients with cardiovascular disease. Finally, it calls for a shift in the management of COPD towards proactive cardiopulmonary risk reduction to improve clinical outcomes and reduce mortality.This narrative review defines cardiopulmonary risk as the risk of serious respiratory and/or cardiovascular events in patients with chronic obstructive pulmonary disease (COPD). It highlights the significant burden of COPD and its association with cardiovascular disease, emphasizing the need for proactive management to reduce this risk. The review discusses the elevated cardiopulmonary risk in COPD patients, which can lead to early death, and the importance of identifying and managing exacerbations to prevent adverse outcomes. It reviews current evidence supporting therapeutic interventions to reduce exacerbation risk and improve clinical outcomes, including the use of inhaled therapies such as triple therapy (ICS/LAMA/LABA). The review also explores the mechanisms by which these therapies may provide cardiopulmonary protection and the need for early detection and treatment of COPD in patients with cardiovascular disease. Finally, it calls for a shift in the management of COPD towards proactive cardiopulmonary risk reduction to improve clinical outcomes and reduce mortality.