The exposome — comprising aging, Western lifestyle patterns, and drugs — reshapes the gut microbiota, elevating noxious metabolites (e.g., TMAO, PAA, PAGln, ImP, trimethyllysine [TML], TMAVA, p-cresol sulfate [p-CS]) while depleting protective ones (e.g., SCFAs, IAA, IPA). This metabolic imbalance accelerates mechanisms underpinning adverse cardiovascular outcomes, including ASCVD and heart failure. Integrated deep fecal microbiome sequencing and plasma metabolomics, supported by advanced bioinformatics, enable the characterization of microbial age metric and metabolite panels, providing personalized late-life CVD risk prediction and establishing targeted interventions. Next-generation microbiome-based strategies — including fecal microbiota transplantation, microbial enzyme inhibitors, host-microbe genetic manipulation, and engineered probiotics — offer translational opportunities to enrich beneficial taxa, suppress CVD-associated pathways, and boost protective metabolite production, thereby advancing precision cardiovascular medicine and decelerating cardiovascular aging.