Background: Cardiovascular diseases remain the leading cause of mortality globally, driven largely by modifiable risk factors, such as hyperlipidemia, hypertension, diabetes, and oxidative stress. As conventional pharmaceutical interventions often carry adverse effects and economic burdens, there is growing interest in alternative therapies. Objective: This narrative review explores vinegar, a traditional remedy with historical and cross-cultural usage, as a potential adjunct in cardiovascular health management. Vinegar contains a rich array of bioactive compounds, including acetic acid, polyphenols, amino acids, melanoidins, and tetramethylpyrazine, which may exert antioxidant, anti-inflammatory, lipid-lowering, antihypertensive, and antithrombotic effects. Preclinical studies in animal models and limited human trials indicate promising outcomes in improving lipid profiles, blood pressure regulation, glycemic control, and endothelial function. Despite these benefits, there is a paucity of large-scale, high-quality human studies to validate vinegar’s clinical efficacy and safety. Conclusion: This review underscores the potential of vinegar as a functional food with cardioprotective properties and advocates for further rigorous research to establish standardized dosing, isolate active constituents, and assess long-term outcomes in human populations.