Worldwide, there were over 3 million deaths attributable to exposure to excessive levels of particulate air pollution in 2010. This is similar to the number of deaths attributable to high blood sugar (3.4 million) but less than the number of deaths attributed to smoking (5.7 million) and excessive alcohol consumption (5.0 million). Globally, ambient particulate air pollution was the ninth leading cause of premature deaths, and most of the disease attributable to exposure to ambient particulate air pollution is cardiovascular disease. Short-term and long-term exposures to outdoor particulate matter pollution are associated with a range of adverse cardiovascular health effects such as heart rate variability, development of atherosclerosis, myocardial ischemia, myocardial infarction, stroke, and deaths. Despite this, there is not the same recognition of particulate air pollution as an important risk factor for cardiovascular disease morbidity and mortality compared to the more established risk factors such as cigarette smoking and hypertension. It is now time to reevaluate the contribution of particulate air pollution to cardiovascular disease.