Ten percent of global mortality is attributable to tobacco smoking. Malignancies, respiratory diseases, and cardiovascular diseases each account for one-third of these deaths. Smoking is a substantial risk factor for myocardial infarction, stroke as well as the development of peripheral artery disease and aortic aneurysm. The effects of smoking on the cardiovascular system are particularly pronounced in middle-aged women. In patients with established cardiovascular disease, smoking cessation is the most cost-effective of all secondary prevention measures. Its effects on morbidity and mortality are greater than the effects observed with medical therapy, as recommended in current guidelines. All smoking patients have the right to receive professional help to achieve cessation. Passive smoking significantly increases the risk of acute myocardial infarction and stroke. In order to reduce morbidity and mortality, the general public must be protected against passive exposure to tobacco smoke.