Air pollution contributes substantially to premature mortality and disease burden globally, with a greater impact on low-middle-income countries. Of all the air pollutants described, PM2.5 has been linked to the most significant health problems and premature mortality. PM2.5 is particulate matter with a diameter of 2.5 µm or less and is responsible for approximately 1.27 million attributable deaths per year in India, half of which are caused by its cardiovascular effects. They are emitted mainly by the combustion of fuels for domestic heating, industrial activities, and road transport. Studies have shown a 0.3–15% increase in cardiovascular mortality for every 10 μg/m3 increase in PM2.5. When inhaled, PM2.5 penetrates the lower respiratory tract and reaches the blood initiating extrapulmonary effects on the cardiovascular system via oxidative stress, systemic inflammation, direct damage, and autonomic nervous system dysregulation. These mechanisms accelerate atherosclerosis, endothelial impairment, arterial stiffness, hypercoagulability, and platelet and leucocyte activation that, in turn, lead to increased risk for diabetes, obesity, hypertension, cardiac arrhythmias, myocardial ischemia, heart failure, and stroke. Air pollution represents a major public health threat in India and underscores the importance of comprehensive longitudinal air pollution exposure assessment that can be used with health data to investigate health effects. This review presents an all-inclusive assessment of air pollution trends in India, its association with cardiovascular diseases, and the need for using existing cohort studies to evaluate the prospective effects of ambient air pollution on cardiometabolic health outcomes that might help devise steps for secondary prevention and guide policy reforms.