Purpose of Review <p>Environmental exposures are drivers of cardiovascular disease. These exposures, including climate change, metal toxicants, microplastics, endocrine-disrupting chemicals, and particulate matter, can be inhaled, ingested, or absorbed through water or soil, and can promote atherosclerotic cardiovascular disease (ASCVD) risk factors such as hypertension, dyslipidemia, dysglycemia, and obesity. This review aims to describe environmental contributors to the development of ASCVD risk factors in childhood, with a focus on American Indian/Alaska Native (AI/AN) children as a lens for exploring the linkage between marginalization and toxic exposures.</p> Recent Finding <p>Recent evidence suggests alarming associations between microplastics, endocrine-disrupting chemicals and ASCVD. Exposure to air pollution has also been demonstrated to increase the risk of ASCVD primarily through oxidative stress. Further, climate change impacts cardiovascular health by increasing metabolic demand and disrupting economic supply chains and healthcare delivery. Toxic metal exposures also promote ASCVD through oxidative stress, inflammation, and endothelial dysfunction.&#xa0;</p> <p>Historically marginalized populations bear a disproportionate burden of these exposures, with AI/AN people as an illustrative example. ASCVD remains the most common cause of death in AI/AN people, and data describe an accelerated phenotype. This is likely in part attributable to inequitable environmental exposures driven by settler colonialism-influenced policies and land allocation patterns.</p> Summary <p>Emerging evidence suggests a need for research on the role of environmental exposure prevention in reducing ASCVD risk. Providers must screen for environmental contributors to ASCVD and partner with community resources, tribal communities, and state and federal surveillance efforts to promote the cardiovascular health of all children.</p>