Cardiovascular diseases (CVDs) are the leading cause of death globally. Patients with severe mental disorders (SMIs) bear a significantly higher risk for CVD, attributing to a shorter life expectancy compared to the general population. The etiology of the CVD in patients with SMI is multifactorial, involving genetic and lifestyle factors and disease-specific and treatment effects. Modifiable risk factors, such as obesity, smoking, hypertension, dyslipidemia, and diabetes mellitus, play a significant role in CVD development. Those risks can be attributed to lifestyle and behavioral patterns, and they present at the beginning of the SMI and correlate with the duration of the mental disorder. Sedentary lifestyle, with poor exercise habits and diet, possibly a shared genetic predisposition, the use of long-term antipsychotic medication with a propensity to obesity and metabolic syndrome, treatment gaps, and the lower use of cardiac medications and procedures among persons with SMI contribute to the correlation. According to guidelines, patients with SMI should be routinely screened for CVD risk factors at all stages of the disorder. Management of CVD should focus on prevention by decreasing the risk of CVD, early detection, and treatment. Prevention includes promoting healthy lifestyle, smoking cessation strategies, rational pharmacotherapy for SMI, and increased adherence to psychotropic medication. Treatment of CVD usually requires establishing a healthy lifestyle, reducing risk factors, medications, and medical procedures, if necessary. The treatment principles should follow similar principles as for population without SMI, with an emphasis on adherence to treatment and regular monitoring for outcomes.