en Environmental Health, Sciences, and Engineering Environmental Health, Sciences, and Engineering Review Review Article <div style="text-align: justify;"><span style="line-height:1;"><span style="font-size:14px;"><span style="font-family:Times New Roman;"><span style="color:black">Cardiovascular diseases are the leading cause of death globally and in Iran. Climate change has intensified human exposure to extreme temperatures, thermal variability, and bioclimatic indices. The climate exposome framework offers a comprehensive approach to assessing environmental exposures across the lifespan. This narrative review synthesizes evidence on the climate exposome&#39;s role in the development of cardiovascular diseases and its biological mechanisms. Epidemiological evidence indicates that exposure to extreme temperatures, temperature variability, climate-related air pollution, and extreme events is significantly associated with increased cardiovascular disease mortality, hospitalizations, myocardial infarction, stroke, and heart failure. These effects follow non-linear patterns with temporal lags and are more pronounced among the elderly, individuals with pre-existing heart disease, and lower socioeconomic groups. Proposed biological mechanisms include thermoregulatory disruption, SNS and HPA axis activation, systemic inflammation, oxidative stress, endothelial dysfunction, coagulation abnormalities, and emerging mechanisms such as epigenetic modifications and gut microbiome dysbiosis. Interactions between climatic factors and air pollution generate synergistic effects. Adopting the climate exposome approach in cardiovascular research provides a comprehensive understanding of cumulative environmental exposures, playing a critical role in designing preventive interventions, shaping health policies, and enhancing health system adaptation to climate-related hazards.</span></span></span></span></div> Exposome, Climate change, Temperature, Cardiovascular diseases, Mortality, Narrative review, 0 0 http://jhehp.zums.ac.ir/browse.php?a_code=A-10-650-8&slc_lang=en&sid=1 Mina Esmaeili Masmyly633@gmail.com 100319475328460016889 0009-0001-0023-1007 No Student Research Committee, Department of Environmental Health Engineering, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran. Esrafil Asgari sasgary@gmail.com 100319475328460016890 100319475328460016890 Yes Department of Environmental Health Engineering, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran. Maryam Salimi Ma.salimi@jmu.ac.ir 100319475328460016891 100319475328460016891 No Department of Environmental Health Engineering, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran.