Research on how tobacco and alcohol use interact to influence risk for cardiovascular disease is limited. Alcohol consumption of three or more drinks per day and cigarette smoking share similar, and probably additive, effects on some forms of cardiovascular disease. There is relatively little evidence, however, that the effets are worse when smoking and drinking occur together than would be expected from their independent effects. In most cases, moderate drinking does not share these risks and even has opposite effects of cigarette smoking on some risk factors. Ongoing public health efforts to minimize tobacco use and harmful drinking should result in clear and important gains to the nation's cardiovascular well-being.