In Italy cardiovascular diseases (CD) are the main cause of death. On the number of cardiovascular diseases attributable to occupational exposure is very limited. The INAIL list of occupational diseases identifies four types of exposure able to cause a specific CD while the list of DM 19.12.2009 cites two CD with high probability to be linked to occupational exposure and two as possible occupational origin. The literature analysis shows that only the noise occupational exposure (possible origin) could cause a high prevalence of CD and that there are two different relevant occupational risk factors as stress and shift work. Consequently also CD are classifiable as work related diseases. In consequence of the difficulty to identify a good tool to evaluate the weight of occupational exposure on origin of CD, it could be advisable to focus mainly on the identification of specific activities of health prevention and promotion and to define a standard strategy of cardiopathic patient's fitness to work evaluation.