Cardiovascular disease (CVD) remains the leading cause of death globally. Alongside diet and pharmacotherapy, nutraceuticals — defined as food-derived products with health benefits — are widely used to modulate CVD risk factors. This review summarizes mechanisms of action, clinical evidence, safety considerations, and practical recommendations for commonly used nutraceuticals in cardiovascular prevention and management, focusing on lipid-lowering agents (red yeast rice, plant sterols, soluble fiber), omega-3 fatty acids, coenzyme Q10, berberine, garlic, and selected polyphenols and micronutrients. Evidence strength varies: some agents reliably lower LDL-C (plant sterols, red yeast rice, soluble fiber), while outcome data (hard CVD end-points) are clearer for only a few agents and remain mixed for others (omega-3s). Safety, standardization and interaction potential are important clinical considerations. Overall, nutraceuticals can be useful adjuncts for CVD risk reduction in specific contexts but should not replace guideline-directed therapies for high-risk patients.