Purpose of Review <p>This review examines cardiovascular complications of multiple myeloma and anti-myeloma therapy, emphasising integrated systems-based cardiovascular management and the institutional model developed at the University College London Hospital Cardio-Oncology (CO) Centre of Excellence.</p> Recent Findings <p>Cardiovascular vulnerability in multiple myeloma reflects baseline risk, disease-related factors, including cardiac amyloidosis, and treatment-related cardiotoxicity. A longitudinal approach should begin before therapy with multidimensional risk stratification incorporating patient, disease, and treatment factors, with intermediate- and high-risk patients referred for CO review. During treatment, active surveillance using clinical assessment, cardiac biomarkers and imaging, with vigilance for cardiac amyloidosis, enables rapid CO referral and timely intervention. Survivorship care should include annual cardiovascular review, risk-factor optimisation, and monitoring for late toxicity.</p> Summary <p>Existing evidence and real-world experience support integrated CO services combining rapid-access clinics, high-volume cardiac imaging, timely decision-making, inpatient consultation, multidisciplinary collaboration, and survivorship surveillance while preserving cardiovascular health and access to effective anti-myeloma therapy.</p>