The Cardiovascular Health Study (CHS) is an observational study of heart disease and stroke designed to evaluate risk factors and noninvasive measures and to describe and predict atherosclerotic events in older adults. Five thousand two hundred one individuals ages 65 or older were recruited from a stratified random sample of Medicare recipients from 4 US communities. This review of cross-sectional data from the CHS baseline examination describes the cigarette smoking habits of elderly persons and the relationships of smoking to lung function (spirometry) and atherosclerosis, as noninvasively measured by the ankle-arm index (AAI) and carotid ultrasonography. Only 10% of the men and 13% of the women were current smokers, and about half were former smokers. Forced expiratory flow (FEV1) was about 20% lower in current smokers when compared with never smokers. Current and former smoking were strongly associated with an increased risk for an abnormal AAI. Common and internal carotid artery walls were thicker and stenosis more common in current smokers and former smokers, when compared with never smokers. Analysis of long-term follow-up morbidity and mortality data from the CHS cohort should provide even stronger evidence of the effects of smoking in the elderly. Vigorous efforts should be made to persuade elderly smokers to quit.