People who smoke tobacco are at increased risk of cardiovascular disease. Tobacco use contributes to the risk of all the major types of cardiovascular disease, particularly heart attack, stroke and the blockage of blood vessels in the lower limbs. People with diabetes, especially type 2 diabetes, are also at high risk for cardiovascular diseases; and the combination of diabetes and tobacco smoking further increases the risk of these cardiovascular diseases as well as exacerbating diabetes complications, such as kidney failure or eye damage. Furthermore, evidence has emerged over recent decades to suggest an association between cigarette smoking and the development of type 2 diabetes. Gary Ko and Clive Cockram report.