<p>Ambient air pollution is a&#xa0;leading modifiable environmental determinant of cardiovascular morbidity and mortality worldwide. Long-term and short-term exposure to fine particulate matter and traffic-related pollutants is consistently associated with an increased risk of ischemic heart disease, stroke, heart failure, arrhythmia and cardiovascular death. Mechanistic studies demonstrate that inhaled pollutants induce pulmonary and systemic oxidative stress, inflammation, endothelial dysfunction, autonomic imbalance and prothrombotic changes, providing biological plausibility for these associations. Air pollution rarely acts in isolation but clusters with other environmental stressors, such as transportation noise, heat and limited access to green space and disproportionately affects socioeconomically disadvantaged and medically vulnerable groups. This review summarizes the current evidence on the cardiovascular effects of air pollution, highlights high-risk populations and discusses clinical, public health and policy strategies to reduce exposure and vulnerability. We argue that contemporary cardiovascular prevention must adopt an exposome-oriented perspective and engage with transport, energy, housing and urban planning policies to effectively protect vulnerable patients and communities.</p>