Abstract Food production in areas contaminated with heavy metals is associated with health risks because of their adverse effects on food safety and marketability, and on crop growth and yield quality. The present review focuses on sources and risks of heavy metals, mainly in cultivated fields in various regions, and strategies to reduce their accumulation in horticultural crops. The following heavy metals are discussed: arsenic (As), boron (B), cadmium (Cd), chromium (Cr), cobalt (Co), copper (Cu), iron (Fe), lead (Pb), mercury (Hg), molybdenum (Mo), nickel (Ni), strontium (Sr), tin (Sn), titanium (Ti), vanadium (V) and zinc (Zn). Heavy metal sources in the environment can originate from natural and anthropogenic activities. Their main natural enrichment in soils stems from parent-material weathering. However, in coastal areas, precipitation of sea spray may enrich soil with B. In contrast, the main anthropogenic sources of heavy metals in cultivated areas are irrigation with treated sewage water, application of residual biosolids, and atmospheric pollution. Plants absorb heavy metals predominantly through roots and, to a lesser extent, through leaves. Leaf uptake can occur through the stomata, cuticular cracks, ectodesmata, and aqueous pores. Heavy metal uptake may lead to their accumulation in vegetables and fruit trees, and their consequent introduction into the food chain, which is recognized as one of the major pathways for human exposure to them. This exposure can result in retardation, several types of cancer, kidney damage, endocrine disruption, and immunological and neurological effects. High concentrations of heavy metals can also affect the growth and yield of many crops: Zn and Cd decrease plant metabolic activity and induce oxidative damage; Cu generates oxidative stress and reactive oxygen species; Hg can induce visible injury and physiological disorders; Cr affects photosynthesis in terms of CO2 fixation, electron transport, photophosphorylation and enzyme activities; Pb induces plant abnormal morphology; Ni spoils the nutrient balance, resulting in disorders of cell membrane functions; Fe causes free radical production that irreversibly impairs cell structure and damages membranes, DNA and proteins; As causes leaf necrosis and wilting, followed by root discoloration and retardation of shoot growth. Therefore, international organizations, such as the US EPA and EU bodies, are working on regulating the maximum allowable levels of food pollutants. A number of direct (mycorrhiza, transgenic plants and grafting) approaches can be deployed to overcome problems of heavy metal contamination in horticulture.