Due to the aging population, secondary cardiovascular prevention in older adults has become a major clinical concern. Older patients with cardiovascular diseases usually have complex health conditions due to overlapping chronic diseases and functional decline. Cognitive impairment is prevalent in patients with cardiovascular disease, possibly due to common risk factors, interrelationships, and disease-specific mechanisms that induce cognitive decline. Cognitive impairment is associated with poor treatment adherence and difficulty in self-care management for secondary prevention, leading to an increased risk of poor clinical outcomes. Cognitive assessment should be considered a standard clinical measurement in routine practice for planning patient-centered multidisciplinary approaches and reducing modifiable risk factors for cognitive impairment. This chapter provides an overview of cognitive impairment as a major comorbidity in cardiovascular practice and discusses tailored secondary prevention plans for older patients.