<p>Hypothyroidism, which is characterized by reduced thyroid hormone production, affects approximately 5% of the general population. Although primarily associated with metabolic and endocrine alterations, hypothyroidism has also been associated with an increased risk for cardiovascular disease (CVD), mainly due to accelerated atherosclerosis. Although the association between overt hypothyroidism and CVD is well established, that between subclinical or mild hypothyroidism and CVD remains questionable. CVD is among the most common non-communicable diseases and is the leading cause of death globally. The present narrative Review delves into the intricate relationship between hypothyroidism and cardiovascular risk factors. It explores the biochemical and molecular mechanisms underlying the heightened susceptibility of the hypothyroid state to CVD, while also seeking to identify potential avenues for improving management and designing preventive strategies via examination of both conventional and new risk factors. Furthermore, the Review scrutinizes the reported role of thyroid hormones in modulating cardiac structure and function, to shed light on their influence on the development and progression of CVD. Risk evaluation and personalized treatment approaches for individuals with hypothyroidism are also discussed.</p>