It is estimated that during the 20th century, 100 million people died of tobacco-related illnesses worldwide. The outlook for the future is grim as this number is expected to increase 10-fold during the 21st century. Many of these deaths will occur in middle-aged adults and, while most tobacco-related deaths currently occur in men, female mortality is expected to increase markedly due to increased rates of smoking in women, especially in developing countries. The risk of coronary heart disease is strongly associated with smoking in both developed and undeveloped countries. In addition, other forms of tobacco exposure (chewing, inhalation through water, and secondhand smoke) have also been documented to be important causes of coronary disease worldwide. Fortunately, the news is not all bad. Recent large-scale studies show that much of the excess risk associated with smoking is attenuated 1 to 2 years after quitting, depending on the level of smoking during an individual's lifetime. These latest findings should stimulate efforts of health care workers to become more aggressive toward cessation of smoking in our practices.