Objective: To review the literature on associations between cardiovascular diseases and tobacco use, including recent trends in smoking behaviors and clinical approaches for cessation of smoking. Methods: A literature review of recent scientific findings for smoking and cardiovascular diseases and recommendations for obtaining cessation. Results: Tobacco smoking is causally related to cardiovascular disease, with nearly a half million deaths annually attributed to cigarette smoking in the United States. The human, economic, medical, and indirect costs are enormous. Secondhand smoke as inhaled from the environment also plays an important role in the genesis of cardiovascular diseases. A recent trend in the use of e-cigarettes is noted particularly among youth. For children, prevention is the best strategy. For adult smokers, behavioral treatments, self-help approaches, and pharmacologic therapies are readily available. Clinicians can have a significant impact on patients’ smoking habits. Adding to individual strategies, regulatory community and public health approaches provide the potential for eliminating the use of tobacco. Conclusion: Tobacco smoke causes cardiovascular morbidity and death. Clinicians can play a role in preventing smoking and promoting cessation.