Background: Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. The spectrum of cardiovascular diseases and their associated comorbidities varies across regions depending on demographic characteristics, lifestyle factors, and stages of epidemiological transition. Understanding the distribution of cardiovascular diseases and associated risk factors is essential for improving preventive strategies and clinical management. Objectives To evaluate the spectrum of cardiovascular diseases and assess the burden of comorbid conditions among patients attending a tertiary care center in Kerala. Methods A retrospective observational study was conducted using medical records of patients diagnosed with cardiovascular diseases at a tertiary care hospital in Kerala between 2014 and 2016. A total of 302 patients were included in the study. Demographic details, cardiovascular diagnoses, and associated comorbidities were collected from hospital records. A comorbidity score was calculated based on the presence of coexisting diseases. Data were analyzed using descriptive statistics, and associations between variables were assessed using the Chi-square test. Results Among the 302 patients, the majority were male (68.9%), and most belonged to the >60 years age group (62.6%). Coronary artery disease (58.9%) was the most common cardiovascular condition, followed by heart failure (33.4%) and dilated cardiomyopathy (13.9%). The most prevalent comorbidities were diabetes mellitus (60.9%) and hypertension (55%). A significant association was observed between diabetes mellitus and coronary artery disease (χ² = 43.623, p <0.001) as well as between hypertension and coronary artery disease (χ² = 16.275, p <0.001). Increasing age was significantly associated with higher comorbidity scores (χ² = 71.126, p <0.001). Coronary artery disease was significantly more common among male patients (69.2%), while rheumatic heart disease was more prevalent among females (15.1%). Conclusion The study demonstrates that coronary artery disease is the predominant cardiovascular condition, with a high burden of metabolic comorbidities such as diabetes and hypertension. Advancing age is associated with increased comorbidity burden, highlighting the need for comprehensive risk assessment and management strategies. Early detection and effective control of modifiable risk factors may play a crucial role in reducing the burden of cardiovascular diseases.