It has been observed that environmental pollution can have significant etiopathogenic implications for CVDs. Since mass screening of the entire population is not feasible, a substantial contribution to the prevention and early identification of pollution-related CVDs can be achieved through health surveillance, autonomously regulated in each country.

In occupational medicine, health surveillance aims to prevent occupational diseases and work-related illnesses, prevent health conditions from deteriorating due to work-related factors, and contribute to preventing workplace injuries. Health surveillance is a crucial preventive measure for workers exposed to health risks (chemical, physical agents, etc.) that may lead to occupational diseases after varying periods of exposure.

In essence, health surveillance assesses the health effects of such exposure, with the goal of adapting preventive measures to individual workers' specific circumstances and verifying the effectiveness of adopted measures, ensuring that exposed individuals do not experience health issues.

The purpose of health surveillance includes: (A) Assessing specific fitness for work; (B) Identifying categories of workers with genetic or acquired hypersusceptibility; (C) Evaluating co-exposures to cumulative and/or synergistic occupational risks on the same target organ; (D) Detecting clinical or preclinical anomalies for early diagnosis; (E) Preventing worsening of workers' health (secondary prevention); (F) Evaluating the efficacy of preventive measures in the workplace; (G) Reinforcing correct work-related measures and behaviours.

Regarding CVDs, there have been few studies investigating the relationship between exposure to environmental pollution and disruptions in the cardiovascular system. Some scientific studies have focused on specific worker categories: an observational study published in 2007 involving 54,000 transport sector workers (more exposed to pollutants) found an increased risk of cardiac pathologies compared to the general population, with a 49% increased risk for truck drivers, 32% for port workers, and 34% for small transporters [15]. Consistently, a report on highway police officers associated particulate matter exposure with heart rate alterations and increased inflammatory markers. Exposure to particulate matter has also been identified as a cause of premature death in two major studies on environmental pollution [16]. Diesel emissions can increase the risk of developing blood clots and stroke. Experimental studies and epidemiological data revealed that the risk more than doubled after 2 hours of exposure to high levels of particulate matter [17, 18].

Given these considerations, it is evident that gaining more information about the effects of environmental pollution, especially on CVDs, is crucial for developing both socioeconomic interventions and public health measures.

Reiterating the potential role of health surveillance, it appears necessary to reconfigure both the risk assessment system (not of medical relevance) and the visit protocol. Particularly noted is the absence of guidelines or specific indications for this specific risk factor in subjects exposed to environmental pollutants. Preventive medical examinations should encompass clinical, instrumental, and laboratory assessments aimed at monitoring not only the potential effects of environmental pollutants but also the presence of biochemical alterations that may have a co-causal or synergistic role in the onset of CV diseases.

To identify symptoms early during the medical visit, the use of structured and standardized questionnaires and rating scales can be employed as tools to identify characteristic symptoms of exposure to pollutants or simultaneous exposure to cigarette smoke. In this regard, the use of questionnaires to assess smoking habits, such as the “Cigarette Dependence Scale” [19], could be useful. This scale exists in two forms: a longer version with 12 questions (CDS-12) and a shorter version with 5 questions (CDS-5). These provide a quantitative, continuous, and unidimensional measure of dependence, with particular attention to the compulsion to smoke, abstinence, locus of control, time management, and the abandonment of other activities. It is always important to remember the role of the competent physician as a point of reference capable of providing support, listening, and assistance to actively counteract such habits. Further investigation into possible indicators is also advisable. Various scientific publications consider Elemental Carbon (EC) to be a reliable indicator of exposure to pollutants, if feasible, seek related work. EC refers to the fraction of atmospheric particulate matter that contains only carbon, not bound to other elements, and its various allotropic forms. It is a fundamental part of particulate matter and can absorb organic compounds such as polycyclic aromatic hydrocarbons (PAHs), oxidized PAHs, nitro-PAHs, and small amounts of sulfates, nitrates, metals, and other trace elements (Table 1).

Thus, health surveillance of workers, especially those exposed to environmental pollutants, can represent a fundamental preventive tool for the development of economic, social, and health policies concerning the entire population. Therefore, it is advisable to: (A) Reconsider occupational risk factors, including environmental pollution as a co-factor in the genesis of cardiovascular diseases, especially for certain categories of workers, (B) Modify and implement the health protocol, including among the standard examinations: (1) Specific questionnaires, including those related to smoking habits; (2) Hematochemical tests, including blood glucose and lipid profile; (3) Electrocardiogram (ECG) and potentially echocardiogram.

Clearly, there is a need for further scientific investigation with the collection of an adequate amount of data for statistical and epidemiological purposes.