Frailty (the loss of physiological reserve to withstand a stressor response) is associated with an increase in vascular risk and cardiovascular disease, and exerts marked disease- and treatment-modifying effects on cardiovascular outcomes and treatments. Frailty is anticipated to rise as the global population ages, resulting in an increase in the burden of cardiovascular morbidity and mortality that will have clear implications for the demand on healthcare services. However, despite these challenges, frailty may also represent an opportunity as a therapeutic target to reduce cardiovascular disease, and consequently direct a strategy to promote healthy ageing. Conversely, frail individuals may benefit from less intervention and polypharmacy, through a more holistic, person-centred approach. This review will consider the role of frailty in vascular risk factors and their inter-relationships, the impact of frailty on vascular risk management and treatment and the implications for research and clinical care in order to meet and minimise the burden of cardiovascular disease in individuals with frailty.