<p>The global rise in life expectancy underscores the urgent need to extend healthspan and prevent age-related diseases. Cardiovascular disease is the leading cause of death worldwide, with ageing as a major non-modifiable risk factor. Ageing drives progressive vascular dysfunction and cardiac decline, including heart failure with preserved or reduced ejection fraction. Vascular cells are particularly vulnerable to ageing, resulting in structural and functional deterioration of the microvasculature and macrovasculature. Emerging evidence highlights that ageing also disrupts the neurovascular interface — an intricate axis between the nervous and vascular systems that governs cardiac function. Alterations to the neurovascular unit in the heart contribute to impaired autonomic regulation, increasing the risk of arrhythmias and heart failure. In this Review, we examine how neurovascular ageing shapes cardiac dysfunction and explore the therapeutic potential of targeting the cardiac neurovascular unit to mitigate cardiovascular ageing and promote resilience in ageing populations.</p>