Objectives: There are few studies about the association between breathing polluted air and increased risk of cardiovascular diseases and cardiac death in the Middle East. This study aimed to investigate the relation between air pollutants and cardiovascular mortality (based on ICD-10) in Ahvaz. Material and methods: In this ecological study, the data about cardiovascular disease mortality and air pollutants from March 2008 until March 2015 was inquired from the Ahvaz City Authority and the Khuzestan Province Environmental Protection Agency. The quasi-Poisson, second degree polynomial constrained, distributed lag model; using single and cumulative lag structures, adjusted by trend, seasonality, temperature, relative humidity, weekdays and holidays was used for the data analysis purposes. Results: Findings indicated a direct significant relation between an interquartile range (IQR) increase in ozone and cardiovascular deaths among men after 3 days’ lag. There was also a significant relation between an IQR increase in particulate matter below 10 μm and cardiovascular deaths for all people, over 60 years old and under 18 years old after 3 and 13 days’ lags. There was a significant relation between an IQR increase in nitrogen dioxide and carbon monoxide, and cardiovascular deaths in the case of under 18-year-olds (in the lag 11) and over 60-year-olds (in the lag 9), respectively. We finally found a significant association between an IQR increase in sulfur dioxide and cardiovascular deaths in the case of men, under 18-year-olds and from 18- to 60-year-olds in the lag 9, 0, and 11, respectively (p-values < 0.05). Conclusions: It appears that air pollution is significantly associated with cardiovascular deaths in Ahvaz City. Int J Occup Med Environ Health 2018;31(4):459–473