Tobacco use is the leading preventable cause but often underestimated by clinicians as a risk factor for cardiovascular diseases (CVDs) in comparison of hypertension, diabetes or hyperlipidemia. Tobacco products can be smoked, chewed or snuffed. Tobacco has myriad manifestations on cardiovascular system and has been implicated in CVD pathophysiology. It increases the risk of AMI and ACS, stroke, and peripheral vascular disease. The mainstream smoke is inhaled and exhaled by the smoker whereas the sidestream smoke comes from the burning end of the cigarette. Concerns of harmful effects of smoking initially centered on lung diseases but vascular diseases occur early in life (than lung diseases) and contribute to substantial deaths. Cigarette smoking is known to increase the risk of CVD similar to hypertension, hypercholesterolemia and diabetes. Coronary artery disease (CAD) events follow atherosclerosis and cigarette smoking is an important risk factor in the development of CAD because there is four times more risk of atherosclerosis in smokers. The chapter also mentions on tobacco cessation interventions, challenges to tobacco control.