Tobacco consumption has been inextricably intertwined with society and its evolution. At one time, centuries ago, thought to be a sign of refinement and nobility, fortunately, this perception has been changing worldwide. Currently, this change in perception has been so dramatic that laws are enacted to limit tobacco exposure through second-hand smokers. Countless studies continue to emerge on tobacco's healthcare toll to the point that we now consider indisputable facts that smokers have a higher incidence of coronary artery disease, peripheral vascular disease, chronic obstructive pulmonary disease, stroke, among many others. However, there are other less well-known emerging facts that still require close attention such as the effect on the immune and hematopoietic systems. Tobacco smoke is injurious to all major organs in our bodies. With over 30 known carcinogens, it should not be surprising that it affects all aspects of human health. In this chapter, we will focus on the effects of tobacco on cardiovascular health.