Heat events are increasing in frequency, duration and intensity as global temperatures continue to rise. High temperatures are associated with an increased risk of cardiovascular events, particularly in individuals with pre-existing cardiovascular diseases. The distinct pathophysiological mechanisms underlying the association between heat exposure and cardiovascular events are the subject of ongoing investigations and, according to the current understanding, include increased activation of the sympatho-adrenergic and hypothalamic-pituitary-adrenal axes, increased cardiac load with subsequent mismatch between cardiac oxygen supply and oxygen consumption as well as inflammatory and thrombotic stimuli. It is important that cardiologists take an active role in health-related heat protection. Raising awareness of cardiologists for the cardiovascular consequences of heat exposure, including through education and training, helps to recognize heat-specific risk situations, to counsel patients accordingly and to optimize clinical care paths. The development and implementation of comprehensive heat-health action plans offers potential to prevent heat-related health risks and deaths. The aim of this review article is therefore to elucidate the association between heat and cardiovascular diseases from a pathophysiological, epidemiological, and public health perspective. The overarching aim is (i) to raise awareness of the risks of heat for cardiovascular health, (ii) to demonstrate the importance of practical concepts for measures to adapt to climate change for health protection, in particular for the vulnerable subgroup of the population with pre-existing cardiovascular diseases and (iii) to provide a perspective on the possibilities to mitigate the cardiovascular sequelae of heat.